Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2689 | NC |
Y | 103T00000X | Psychologist | 2689 | NC |
NPI | 1013379817 |
---|---|
Provider Name | Virginia Ann Edwards |
First Address | Angier, NC 27501-5907 |
Second Address | Angier, NC 27501-5907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 22/03/2016 |