Provider Demographics
NPI:1306383245
Name:EDWARDS, KENNETH F (LPCC, LCPC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:F
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LPCC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 DOUGLASS ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2424
Mailing Address - Country:US
Mailing Address - Phone:214-662-1040
Mailing Address - Fax:
Practice Address - Street 1:155 MONTGOMERY ST STE 507
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4110
Practice Address - Country:US
Practice Address - Phone:415-494-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional