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NPI Code Detail

MEDICARE: DR. ANNE WYNNE EDENS PSY.D.

MEDICARE: DR. ANNE WYNNE EDENS PSY.D.
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
1103TC0700XClinical Psychologist1563SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831217116
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANNE WYNNE EDENS PSY.D.
Provider Business Mailing Address
First Line : 2962 MEDICAL PLAZA DR.
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406
Country : US
Telephone Number : 843-797-3636
Fax Number : 843-797-3637
Provider Business Practice Location Address
First Line : 2962 MEDICAL PLAZA DR.
Second Line :
City : NORTH CHARLESTON
State : SC
Zip : 29406
Country : US
Telephone Number : 843-797-3636
Fax Number : 843-797-3637
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 12/15/2021

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