Provider Demographics
NPI:1366862435
Name:EDWARDS, YVONNE J (LPC)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:3862 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-2442
Mailing Address - Country:US
Mailing Address - Phone:503-338-7202
Mailing Address - Fax:
Practice Address - Street 1:#10 PIER ONE
Practice Address - Street 2:SUITE 204
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6338
Practice Address - Country:US
Practice Address - Phone:503-741-7418
Practice Address - Fax:503-325-2903
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3376101YP2500X
CAMFC24401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist