Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003218066 |
---|---|
Provider Name | Alexandra Edwards |
First Address | Riviera Beach, FL 33404-5003 |
Second Address | Riviera Beach, FL 33404-5003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2014 |
Last Update Date | 22/09/2014 |