Provider Demographics
NPI:1295402220
Name:LANIER, LAUREN TAYLOR
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:TAYLOR
Last Name:LANIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4447 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5437
Mailing Address - Country:US
Mailing Address - Phone:404-783-6910
Mailing Address - Fax:
Practice Address - Street 1:4447 PARK ST
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5437
Practice Address - Country:US
Practice Address - Phone:404-783-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician