Provider Demographics
NPI:1376721688
Name:PATRICIA J. EDWARDS, LMSW/ACSW, P.C.
Entity Type:Organization
Organization Name:PATRICIA J. EDWARDS, LMSW/ACSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JANICE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW/ACSW
Authorized Official - Phone:616-842-4820
Mailing Address - Street 1:1620 WAVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2353
Mailing Address - Country:US
Mailing Address - Phone:888-284-5129
Mailing Address - Fax:616-844-4414
Practice Address - Street 1:225 E EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-2020
Practice Address - Country:US
Practice Address - Phone:888-284-5129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010333101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty