Provider Demographics
NPI:1235408246
Name:EDWARDS, AMANDA TAYLOR (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:TAYLOR
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:TAYLOR
Other - Last Name:POINDEXTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NC
Mailing Address - Zip Code:28675-0192
Mailing Address - Country:US
Mailing Address - Phone:828-406-0918
Mailing Address - Fax:888-507-3159
Practice Address - Street 1:115 ATWOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NC
Practice Address - Zip Code:28675-9299
Practice Address - Country:US
Practice Address - Phone:336-467-0489
Practice Address - Fax:888-507-3159
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-20
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008165104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker