Provider Demographics
NPI:1891330221
Name:TAYLOR FLOWERS, EDWINA RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:RENEE
Last Name:TAYLOR FLOWERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EDWINA
Other - Middle Name:RENEE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LTC
Mailing Address - Street 1:5024 STONEY POINT CIR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3735
Mailing Address - Country:US
Mailing Address - Phone:404-512-3244
Mailing Address - Fax:770-284-6612
Practice Address - Street 1:2900 CHAMBLEE TUCKER RD BLDG 5
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4100
Practice Address - Country:US
Practice Address - Phone:833-902-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health