Provider Demographics
NPI:1295210110
Name:THOMPSON, TAYLOR M (BCABA, CRC, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BCABA, CRC, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 POWERS FERRY RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9410
Mailing Address - Country:US
Mailing Address - Phone:770-565-3045
Mailing Address - Fax:770-565-3046
Practice Address - Street 1:4994 LOWER ROSWELL RD STE 10
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4332
Practice Address - Country:US
Practice Address - Phone:770-565-3045
Practice Address - Fax:770-565-3046
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01-18-8916106E00000X
GA445974225C00000X
GALPC014506101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor