Healthcare Provider Details

I. General information

NPI: 1679664015
Provider Name (Legal Business Name): MARY LINDA EDWARDS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 LANGHORNE RD SUITE 104
LYNCHBURG VA
24501-1121
US

IV. Provider business mailing address

2215 LANGHORNE RD SUITE 104
LYNCHBURG VA
24501-1121
US

V. Phone/Fax

Practice location:
  • Phone: 434-455-3047
  • Fax: 434-948-4918
Mailing address:
  • Phone: 434-455-3047
  • Fax: 434-948-4918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904000446
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: