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NPI Code Detail

MEDICARE: MS. JENNIFER EDGE LCSW

MEDICARE: MS. JENNIFER EDGE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YP2500XProfessional Counselor
3103TB0200XCognitive & Behavioral Psychologist
4103TC1900XCounseling PsychologistCSW007295
5103TP2701XGroup Psychotherapy Psychologist
6172V00000XCommunity Health Worker
71041C0700XClinical Social WorkerCSW007295GA

General Provider Information

NPI Number : 1467920975
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER EDGE LCSW
Provider Business Mailing Address
First Line : 224 WINDY HILL RD
Second Line : SUITE 300
City : MARIETTA
State : GA
Zip : 30067-8430
Country : US
Telephone Number : 770-933-5328
Fax Number : 470-980-0507
Provider Business Practice Location Address
First Line : 2470 WINDY HILL RD SE STE 300
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8621
Country : US
Telephone Number : 770-933-5328
Fax Number : 470-980-0507
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2018
Last Update Date : 03/28/2024

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