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General NPI Number Information
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NPI Number | 1437340130
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Entity Type | Individual
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Provider Name | TAMMY E. EDGE LPC, EDS
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Gender | Female
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 11/01/2016
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Provider Practice Location Address
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Address Line | 306 ACADEMY AVE STE 206
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City | DUBLIN
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State | GA
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Zip | 31021-5286
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Country | US
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Telephone | 478-216-6708
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Fax | 478-272-8181
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Provider Business Mailing Address
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Address Line | 1101 HILLCREST PKWY # 227
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City | DUBLIN
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State | GA
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Zip | 31021-3562
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Country | US
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Telephone | 478-290-5148
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Fax | 478-272-8181
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 004884
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 454690
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License Number State | GA
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