=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700858685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH MICHELLE EDWARDS PSY D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 780 LYNNHAVEN PKWY SUITE 400 ATLANTIC PSYCHIATRIC SERVICES
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-7332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-468-0550
-----------------------------------------------------
Fax | 757-468-9992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 780 LYNNHAVEN PKWY SUITE 400
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23452-7332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-468-0550
-----------------------------------------------------
Fax | 757-468-9992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 0810003000
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------