Provider Demographics
NPI:1245719426
Name:TAYLOR, ANTONIA LAMOI (MA-LAPC)
Entity type:Individual
Prefix:MISS
First Name:ANTONIA
Middle Name:LAMOI
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA-LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 TREE LODGE PKWY
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2187
Mailing Address - Country:US
Mailing Address - Phone:404-644-0214
Mailing Address - Fax:
Practice Address - Street 1:2459 ROOSEVELT HWY # B1516
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-5512
Practice Address - Country:US
Practice Address - Phone:404-644-0214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005413101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional