Provider Demographics
NPI:1518312768
Name:EDWARDS, GEOFFREY (LAC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LAC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 DEWEY RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-4882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11815 DEWEY RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4882
Practice Address - Country:US
Practice Address - Phone:301-842-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02124171100000X
MDATC116221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist