Healthcare Provider Details

I. General information

NPI: 1437071107
Provider Name (Legal Business Name): WESLEY EDWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 THOMAS GREEN BLVD
CLEMSON SC
29631-2167
US

IV. Provider business mailing address

252 THOMAS GREEN BLVD
CLEMSON SC
29631-2167
US

V. Phone/Fax

Practice location:
  • Phone: 704-572-2950
  • Fax:
Mailing address:
  • Phone: 704-572-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-26360
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: