Provider Demographics
NPI:1598188716
Name:TAYLOR, TIFFANY (LPC, MED)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LPC, MED
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LATONYA
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-1827
Mailing Address - Country:US
Mailing Address - Phone:478-445-4817
Mailing Address - Fax:478-445-4963
Practice Address - Street 1:900 BARROWS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-8520
Practice Address - Country:US
Practice Address - Phone:478-445-5518
Practice Address - Fax:478-445-4963
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005986101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional