Provider Demographics
NPI:1225452717
Name:TAYLOR, LORNA ELICA (LPC)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:ELICA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0624
Mailing Address - Country:US
Mailing Address - Phone:678-396-8855
Mailing Address - Fax:770-995-1959
Practice Address - Street 1:265 W PIKE ST
Practice Address - Street 2:STE 4
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4896
Practice Address - Country:US
Practice Address - Phone:678-396-8855
Practice Address - Fax:770-995-1959
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional