Healthcare Provider Details

I. General information

NPI: 1457186132
Provider Name (Legal Business Name): SHIRRA EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 S GLEBE RD STE 300
ARLINGTON VA
22204-1672
US

IV. Provider business mailing address

2200 WILSON BLVD STE 102 #275
ARLINGTON VA
22201
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-0703
  • Fax:
Mailing address:
  • Phone: 843-814-8053
  • 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:
Title or Position:
Credential:
Phone: