Provider Demographics
NPI:1255656393
Name:TRAYLOR-ADOLPH, KAREN B (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:B
Last Name:TRAYLOR-ADOLPH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:B
Other - Last Name:TRAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:698 N MARIETTA PKWY NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1585
Mailing Address - Country:US
Mailing Address - Phone:770-919-9088
Mailing Address - Fax:
Practice Address - Street 1:698 N MARIETTA PKWY NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1585
Practice Address - Country:US
Practice Address - Phone:770-919-9088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004083101YM0800X
GAPSY004385103TC0700X, 103TC0700X
MO2018030709103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health