Provider Demographics
NPI:1811038359
Name:EDMONDSON, JOANNE HOLT (PHD, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:HOLT
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 NORTH AVENUE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528
Mailing Address - Country:US
Mailing Address - Phone:706-348-8674
Mailing Address - Fax:
Practice Address - Street 1:42 NORTH AVENUE SUITE 100
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528
Practice Address - Country:US
Practice Address - Phone:706-348-8674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional