Provider Demographics
NPI:1124731112
Name:EDWINS, EMMA TERRY (LPCC)
Entity type:Individual
Prefix:MS
First Name:EMMA
Middle Name:TERRY
Last Name:EDWINS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 NEVADA AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1538
Mailing Address - Country:US
Mailing Address - Phone:612-594-1411
Mailing Address - Fax:
Practice Address - Street 1:6160 SUMMIT DR N STE 375
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2251
Practice Address - Country:US
Practice Address - Phone:763-560-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional