Provider Demographics
NPI:1114384054
Name:EDWARDS, ELIZABETH LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COMMERCIAL BLVD
Mailing Address - Street 2:PO BOX 204301
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30917-4301
Mailing Address - Country:US
Mailing Address - Phone:706-814-6429
Mailing Address - Fax:706-814-6429
Practice Address - Street 1:930 GLENHAVEN DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-0445
Practice Address - Country:US
Practice Address - Phone:706-814-6429
Practice Address - Fax:706-814-6429
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2023-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008635101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003283182AMedicaid
1576028OtherAVAILITY