Healthcare Provider Details

I. General information

NPI: 1528674223
Provider Name (Legal Business Name): ERICA EDWARDS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 CENTRAL AVE STE 9
KEARNEY NE
68847-8126
US

IV. Provider business mailing address

3710 CENTRAL AVE STE 9
KEARNEY NE
68847-8126
US

V. Phone/Fax

Practice location:
  • Phone: 308-251-2222
  • Fax:
Mailing address:
  • Phone: 308-251-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERICA EDWARDS
Title or Position: OWNER
Credential: LIMHP, LCSW
Phone: 308-289-6884