Provider Demographics
NPI:1386897791
Name:EDMONDS, MARCIE HELENE (MC, LPC)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:HELENE
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 S 48TH ST STE 116
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-9137
Mailing Address - Country:US
Mailing Address - Phone:602-460-8270
Mailing Address - Fax:
Practice Address - Street 1:15215 S 48TH ST STE 116
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9137
Practice Address - Country:US
Practice Address - Phone:602-460-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCC-1811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional