Provider Demographics
NPI:1275145187
Name:MCCLENDON, TAYLOR (APC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 HUFF RD NW UNIT 1511
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4639
Mailing Address - Country:US
Mailing Address - Phone:770-827-8131
Mailing Address - Fax:
Practice Address - Street 1:2801 BUFORD HWY NE STE T60
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2145
Practice Address - Country:US
Practice Address - Phone:770-827-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-21
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health