Provider Demographics
NPI:1609316629
Name:EDENFIELD, NATOSHA (LPC)
Entity Type:Individual
Prefix:
First Name:NATOSHA
Middle Name:
Last Name:EDENFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 BROOKLET SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-6468
Mailing Address - Country:US
Mailing Address - Phone:912-531-6492
Mailing Address - Fax:888-241-9172
Practice Address - Street 1:327 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-5418
Practice Address - Country:US
Practice Address - Phone:912-531-6492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional