MEDICARE: TARA R. EDWARDS LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701007894	VA

General Provider Information

NPI Number	:	1043787856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA R. EDWARDS LPC, NCC

Provider Business Mailing Address
First Line	:	1600 WILSON BLVD STE 702
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-2505
Country	:	US
Telephone Number	:	202-415-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 WILSON BLVD STE 702
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-2505
Country	:	US
Telephone Number	:	202-415-0386
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	01/25/2026

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