Provider Demographics
NPI:1639500226
Name:EDMONDS, GARRY (BS)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 CAMSON RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-1407
Mailing Address - Country:US
Mailing Address - Phone:864-260-2237
Mailing Address - Fax:
Practice Address - Street 1:515 CAMSON RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-1407
Practice Address - Country:US
Practice Address - Phone:864-260-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor