Healthcare Provider Details

I. General information

NPI: 1588028930
Provider Name (Legal Business Name): DAVID ANDREW EDWARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 CHAIN BRIDGE RD STE C
FAIRFAX VA
22030-3246
US

IV. Provider business mailing address

22062 AVONWORTH SQ
BROADLANDS VA
20148-6015
US

V. Phone/Fax

Practice location:
  • Phone: 703-380-9045
  • Fax:
Mailing address:
  • Phone: 703-309-2075
  • Fax: 703-349-2770

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: