Provider Demographics
NPI:1366817231
Name:SCULLY, AMY TAYLOR (LCSW, MSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:TAYLOR
Last Name:SCULLY
Suffix:
Gender:F
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 KIRK RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4529
Mailing Address - Country:US
Mailing Address - Phone:404-310-2275
Mailing Address - Fax:
Practice Address - Street 1:735 KIRK RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4529
Practice Address - Country:US
Practice Address - Phone:404-310-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006599104100000X
GACSW006497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker