Provider Demographics
NPI:1295108900
Name:RICHARDSON TAYLOR, KAWANNON (LPC)
Entity type:Individual
Prefix:
First Name:KAWANNON
Middle Name:
Last Name:RICHARDSON TAYLOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 SCOUTING CIR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-2540
Mailing Address - Country:US
Mailing Address - Phone:334-808-8991
Mailing Address - Fax:334-808-8995
Practice Address - Street 1:153 SCOUTING CIR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-2540
Practice Address - Country:US
Practice Address - Phone:334-808-8991
Practice Address - Fax:334-808-8995
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional