Provider Demographics
NPI:1326857228
Name:ATWELL, TAYLOR ALEXANDER (MA, ALC,)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ALEXANDER
Last Name:ATWELL
Suffix:
Gender:M
Credentials:MA, ALC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8134
Mailing Address - Country:US
Mailing Address - Phone:251-776-8544
Mailing Address - Fax:
Practice Address - Street 1:130 KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8134
Practice Address - Country:US
Practice Address - Phone:251-776-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04863101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty