Healthcare Provider Details

I. General information

NPI: 1710177241
Provider Name (Legal Business Name): DR. CYNTHIA ANN EDINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1591 JAMES ADAMS RD
DANIELSVILLE GA
30633-2529
US

IV. Provider business mailing address

1591 JAMES ADAMS RD
DANIELSVILLE GA
30633-2529
US

V. Phone/Fax

Practice location:
  • Phone: 706-795-0058
  • Fax:
Mailing address:
  • Phone: 706-795-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC006772
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: