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General NPI Number Information
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NPI Number | 1285290312
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Entity Type | Individual
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Provider Name | JESSICA STRINGFIELD EDWARDS MA, MSW
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Gender | Female
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 12/06/2019
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Provider Practice Location Address
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Address Line | 4210 COLUMBIA RD STE 1D
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City | MARTINEZ
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State | GA
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Zip | 30907-0436
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Country | US
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Telephone | 706-619-1390
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1521
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City | HARLEM
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State | GA
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Zip | 30814-1521
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CMH0183041
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC7133
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW008863
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC011124
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License Number State | GA
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