Provider Demographics
NPI:1417334194
Name:HOMESLEY, TAYLOR RAE (APC, MAMFT)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:RAE
Last Name:HOMESLEY
Suffix:
Gender:F
Credentials:APC, MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GLENLAKE PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3486
Mailing Address - Country:US
Mailing Address - Phone:678-328-4105
Mailing Address - Fax:770-671-8508
Practice Address - Street 1:50 GLENLAKE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3486
Practice Address - Country:US
Practice Address - Phone:678-328-4105
Practice Address - Fax:770-671-8508
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004069101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor