Provider Demographics
NPI:1316494602
Name:EDWARDS, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 COCHRAN XING
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8072
Mailing Address - Country:US
Mailing Address - Phone:678-886-1824
Mailing Address - Fax:
Practice Address - Street 1:2636 MLK JR DR SW STE 12&22
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1634
Practice Address - Country:US
Practice Address - Phone:678-705-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health