=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518561455
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOY NASHAY EDISON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2020
-----------------------------------------------------
Last Update Date | 11/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4715 LEEDS AVE # L2
-----------------------------------------------------
City | ARBUTUS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21227-1402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-455-0519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4715 LEEDS AVE # L2
-----------------------------------------------------
City | ARBUTUS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21227-1402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-455-0519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------