Provider Demographics
NPI:1174672034
Name:HURLEY, EDNALYN KING (LPC)
Entity Type:Individual
Prefix:MRS
First Name:EDNALYN
Middle Name:KING
Last Name:HURLEY
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 1:105 W MONTCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-5225
Mailing Address - Country:US
Mailing Address - Phone:336-574-3478
Mailing Address - Fax:
Practice Address - Street 1:105 W MONTCASTLE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-5225
Practice Address - Country:US
Practice Address - Phone:336-574-3478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102344Medicaid