Provider Demographics
NPI:1427598465
Name:EDWARDS, JENNIFER PATRICE (LPCMH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PATRICE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 N DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3961
Mailing Address - Country:US
Mailing Address - Phone:302-566-7245
Mailing Address - Fax:302-336-9957
Practice Address - Street 1:504 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3961
Practice Address - Country:US
Practice Address - Phone:302-566-7245
Practice Address - Fax:302-336-9957
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty