Healthcare Provider Details

I. General information

NPI: 1982983151
Provider Name (Legal Business Name): NIKIA K EDWARDS LPC, CSAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 BELVOIR CIR
NEWPORT NEWS VA
23608-7734
US

IV. Provider business mailing address

875 BELVOIR CIR
NEWPORT NEWS VA
23608-7734
US

V. Phone/Fax

Practice location:
  • Phone: 757-817-8100
  • Fax:
Mailing address:
  • Phone: 757-817-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004481
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: