Provider Demographics
NPI:1801649272
Name:TAYLOR, SHAVONTAE ERIKA (LMFT)
Entity type:Individual
Prefix:
First Name:SHAVONTAE
Middle Name:ERIKA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 S HOUSTON LAKE RD STE J100
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9069
Mailing Address - Country:US
Mailing Address - Phone:478-227-0779
Mailing Address - Fax:470-290-6429
Practice Address - Street 1:524 S HOUSTON LAKE RD BLDG J
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9027
Practice Address - Country:US
Practice Address - Phone:478-227-0779
Practice Address - Fax:470-290-6429
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT002058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty