MEDICARE: MRS. LATOYA C.T. EDWARDS LPC

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	5629	SC

General Provider Information

NPI Number	:	1528480068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LATOYA C.T. EDWARDS LPC

Provider Business Mailing Address
First Line	:	1717 GERVAIS ST
Second Line	:	STE. 204
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3415
Country	:	US
Telephone Number	:	803-740-0966
Fax Number	:	803-741-5801

Provider Business Practice Location Address
First Line	:	1717 GERVAIS ST
Second Line	:	STE. 204
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3415
Country	:	US
Telephone Number	:	803-740-0966
Fax Number	:	803-741-5801

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

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	04/15/2024

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