Provider Demographics
NPI:1982416905
Name:EDWARDS, ANGELA BONITA (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BONITA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 701204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-1204
Mailing Address - Country:US
Mailing Address - Phone:313-399-5750
Mailing Address - Fax:
Practice Address - Street 1:1402 S CUSTER RD STE 803
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-1453
Practice Address - Country:US
Practice Address - Phone:469-714-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17161101YA0400X
TX91872101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)