Provider Demographics
NPI:1811566367
Name:EDWARDS, ELIZABETH ASHLEY (LGSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1157
Mailing Address - Country:US
Mailing Address - Phone:304-322-9395
Mailing Address - Fax:
Practice Address - Street 1:930 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2807
Practice Address - Country:US
Practice Address - Phone:304-598-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-20
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker