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General NPI Number Information
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NPI Number | 1700366820
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Entity Type | Organization
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Legal Business Name | EDWARDS MENTAL HEALTH COUNSELING PLLC
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 1115 ELLSWORTH BLVD
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City | MALTA
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State | NY
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Zip | 12020-3320
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Country | US
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Telephone | 518-248-7286
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Fax |
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Provider Business Mailing Address
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Address Line | 61 PLANK RD
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City | WATERFORD
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State | NY
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Zip | 12188-1140
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Country | US
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Telephone | 518-248-7286
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED COUNSELOR
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Name | MRS. NICOLE K EDWARDS
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Credential | LMHC
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Telephone | 518-248-7286
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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 | 006536
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License Number State | NY
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