Healthcare Provider Details

I. General information

NPI: 1114179934
Provider Name (Legal Business Name): BRANDI LASHAYE EDWARDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS BRANDI L LIPMEYER

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 JAMES STREET
JACKSONVILLE AR
72076-3143
US

IV. Provider business mailing address

1815 PLEASANT GROVE RD
JONESBORO AR
72401-7870
US

V. Phone/Fax

Practice location:
  • Phone: 501-982-5000
  • Fax: 501-982-5007
Mailing address:
  • Phone: 870-933-6886
  • Fax: 870-933-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3838-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: