Provider Demographics
NPI:1346741709
Name:EDWARDS, JACLYN MARIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:MARIE
Other - Last Name:CLEVELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1337 LUCIA DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1855
Mailing Address - Country:US
Mailing Address - Phone:214-732-4428
Mailing Address - Fax:
Practice Address - Street 1:220 E MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2948
Practice Address - Country:US
Practice Address - Phone:214-732-4428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66331101YP2500X
PAPC008970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional