Provider Demographics
NPI:1346714839
Name:EDGERSON, SHELITA
Entity Type:Individual
Prefix:MS
First Name:SHELITA
Middle Name:
Last Name:EDGERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 FRANKLIN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-2312
Mailing Address - Country:US
Mailing Address - Phone:504-361-5972
Mailing Address - Fax:
Practice Address - Street 1:1101 FRANKLIN AVE STE B
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-2312
Practice Address - Country:US
Practice Address - Phone:504-361-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health