Provider Demographics
NPI:1316552607
Name:DURM, SARA MACKENZIE TAYLOR
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MACKENZIE TAYLOR
Last Name:DURM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MACKENZIE TAYLOR
Other - Last Name:DURM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA BCBA LBA
Mailing Address - Street 1:289 S CULVER ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:289 S CULVER ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4805
Practice Address - Country:US
Practice Address - Phone:423-505-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-13
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1404103K00000X
GALBA001152103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst