Provider Demographics
NPI:1467536037
Name:EDWARDS, GRACE EDWARDS P (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:GRACE EDWARDS
Middle Name:P
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 WADE HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-1147
Mailing Address - Country:US
Mailing Address - Phone:864-244-1385
Mailing Address - Fax:864-244-1385
Practice Address - Street 1:2511 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1147
Practice Address - Country:US
Practice Address - Phone:864-244-1385
Practice Address - Fax:864-244-1385
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health