Provider Demographics
NPI:1114179934
Name:EDWARDS, BRANDI LASHAYE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:LASHAYE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:BRANDI
Other - Middle Name:L
Other - Last Name:LIPMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1815 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7870
Mailing Address - Country:US
Mailing Address - Phone:870-933-6886
Mailing Address - Fax:870-933-9395
Practice Address - Street 1:1200 JAMES STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3143
Practice Address - Country:US
Practice Address - Phone:501-982-5000
Practice Address - Fax:501-982-5007
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3838-C1041C0700X
AR2524-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5WW24OtherBCBS
AR182045795Medicaid
AR313837YJUJMedicare PIN