Healthcare Provider Details

I. General information

NPI: 1306590328
Provider Name (Legal Business Name): EDGECARE 360 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2470 WINDY HILL RD SE STE 300
MARIETTA GA
30067-8621
US

IV. Provider business mailing address

225 FRANKLIN FARMS CIR
FAYETTEVILLE GA
30214-3363
US

V. Phone/Fax

Practice location:
  • Phone: 770-933-5328
  • Fax:
Mailing address:
  • Phone: 678-561-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER EDGE
Title or Position: CEO/OWNER
Credential: LCSW
Phone: 910-212-2496