Provider Demographics
NPI:1275542789
Name:EDWARDS, JENNIFER SMITH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SMITH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SMITH
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CERT CLIN ADD SPEC
Mailing Address - Street 1:2 CANARY CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6591
Mailing Address - Country:US
Mailing Address - Phone:919-251-8265
Mailing Address - Fax:
Practice Address - Street 1:916 BROAD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4142
Practice Address - Country:US
Practice Address - Phone:919-949-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2791101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor