=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942191226
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIERA EDWARDS ED.S, NCC, LPC-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2025
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 PARK ST STE 102
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29201-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-567-0064
-----------------------------------------------------
Fax | 844-910-1841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 503 PEACHTREE RD
-----------------------------------------------------
City | MARION
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29571-6036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-432-9812
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 10490
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------