=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932758802
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN RENAY EDWARDS LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2019
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 WASHINGTON BLVD FL 4
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22204-5718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-228-0452
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6812 KEYSTONE MANOR DR
-----------------------------------------------------
City | DISTRICT HEIGHTS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20747-3936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-943-1139
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | LC9153
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LC9153
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LC9153
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------