Provider Demographics
NPI:1740927268
Name:WARREN, TAYLOR RAE (EDS, LPC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:RAE
Last Name:WARREN
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:RAE
Other - Last Name:BROKAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1037 PANORAMIC POINTE
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8496
Mailing Address - Country:US
Mailing Address - Phone:470-490-0699
Mailing Address - Fax:
Practice Address - Street 1:11555 MEDLOCK BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-3200
Practice Address - Country:US
Practice Address - Phone:470-490-0699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012995101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional