Provider Demographics
NPI:1083484992
Name:EDMONDSON, AMANDA L (MS MFT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 GARNET CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8191
Mailing Address - Country:US
Mailing Address - Phone:404-450-9685
Mailing Address - Fax:
Practice Address - Street 1:610 GARNET CT
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8191
Practice Address - Country:US
Practice Address - Phone:404-450-9685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist