Provider Demographics
NPI:1780870980
Name:TAYLOR, ALISON LEE
Entity type:Individual
Prefix:MS
First Name:ALISON
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 BRAMWELL LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-2435
Mailing Address - Country:US
Mailing Address - Phone:678-595-0837
Mailing Address - Fax:
Practice Address - Street 1:1042 BRAMWELL LN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-2435
Practice Address - Country:US
Practice Address - Phone:678-595-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108980103TS0200X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool