Provider Demographics
NPI:1235267766
Name:COCHARD, EDMOND (LPA)
Entity Type:Individual
Prefix:
First Name:EDMOND
Middle Name:
Last Name:COCHARD
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 COASTAL HORIZONS DR
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-6094
Mailing Address - Country:US
Mailing Address - Phone:910-754-4515
Mailing Address - Fax:910-754-7997
Practice Address - Street 1:120 COASTAL HORIZONS DRIVE
Practice Address - Street 2:
Practice Address - City:SHALOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470
Practice Address - Country:US
Practice Address - Phone:910-754-4515
Practice Address - Fax:910-754-7997
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4015103T00000X, 103T00000X
NC1742103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)