Provider Demographics
NPI:1255476032
Name:TAYLOR, CARLENE H (LMHC, LPC, CPCS, NCC)
Entity Type:Individual
Prefix:DR
First Name:CARLENE
Middle Name:H
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMHC, LPC, CPCS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 OSBORNE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-8401
Mailing Address - Country:US
Mailing Address - Phone:912-673-9902
Mailing Address - Fax:912-882-0726
Practice Address - Street 1:5035 CLARKS BLUFF RD
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-4690
Practice Address - Country:US
Practice Address - Phone:912-673-9902
Practice Address - Fax:912-882-0726
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3048101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional