Provider Demographics
NPI:1154558526
Name:EDWARDS, BRENDA J (LPC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:J
Last Name:EDWARDS
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 1:1882 PRINCETON AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-3537
Mailing Address - Country:US
Mailing Address - Phone:404-964-6541
Mailing Address - Fax:888-811-6764
Practice Address - Street 1:1882 PRINCETON AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3537
Practice Address - Country:US
Practice Address - Phone:404-964-6541
Practice Address - Fax:888-811-6764
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA203335101YA0400X
GALPC005536101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA882686878AMedicaid