Provider Demographics
NPI:1679021786
Name:EDMUNDS PROGRAMS FOR HUMAN SERVICES INCORPORATED
Entity Type:Organization
Organization Name:EDMUNDS PROGRAMS FOR HUMAN SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BLANCHE
Authorized Official - Middle Name:JAMILA
Authorized Official - Last Name:EDMUNDS-MCCREARY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-545-9857
Mailing Address - Street 1:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-0803
Mailing Address - Country:US
Mailing Address - Phone:407-545-9857
Mailing Address - Fax:
Practice Address - Street 1:1159 S ELM ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-2813
Practice Address - Country:US
Practice Address - Phone:888-444-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-18
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X, 101YP1600X
GA251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251V00000XAgenciesVoluntary or Charitable
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty