Provider Demographics
NPI:1013379817
Name:EDWARDS, VIRGINIA ANN (PHD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 BITTER MELON DR
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-5907
Mailing Address - Country:US
Mailing Address - Phone:919-672-7214
Mailing Address - Fax:
Practice Address - Street 1:9720 BITTER MELON DR
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-5907
Practice Address - Country:US
Practice Address - Phone:919-672-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2689103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist