Provider Demographics
NPI:1326103078
Name:EDWARDS, RACHELLE Y (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:Y
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 MEMORIAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3735 MEMORIAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2202
Practice Address - Country:US
Practice Address - Phone:404-284-2888
Practice Address - Fax:678-623-0148
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY2891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical