Healthcare Provider Details

I. General information

NPI: 1174672034
Provider Name (Legal Business Name): EDNALYN KING HURLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W MONTCASTLE DR
GREENSBORO NC
27406-5225
US

IV. Provider business mailing address

105 W MONTCASTLE DR
GREENSBORO NC
27406-5225
US

V. Phone/Fax

Practice location:
  • Phone: 336-574-3478
  • Fax:
Mailing address:
  • Phone: 336-574-3478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2179
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: