Healthcare Provider Details

I. General information

NPI: 1124818828
Provider Name (Legal Business Name): CRYSTAL DENISE EDMONDS LPC-RESIDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 CANDLERS MOUNTAIN RD APT 1066
LYNCHBURG VA
24502-2240
US

IV. Provider business mailing address

3730 CANDLERS MOUNTAIN RD APT 1066
LYNCHBURG VA
24502-2240
US

V. Phone/Fax

Practice location:
  • Phone: 804-608-9984
  • Fax:
Mailing address:
  • Phone: 804-608-9984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704014941
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: