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General NPI Number Information
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NPI Number | 1982416905
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Entity Type | Individual
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Provider Name | ANGELA BONITA EDWARDS LPC, LCDC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2025
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Last Update Date | 01/25/2025
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Provider Practice Location Address
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Address Line | 1402 S CUSTER RD STE 803
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City | MCKINNEY
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State | TX
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Zip | 75072-1453
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Country | US
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Telephone | 469-714-7558
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 701204
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City | DALLAS
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State | TX
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Zip | 75370-1204
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Country | US
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Telephone | 313-399-5750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17161
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 91872
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License Number State | TX
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