Provider Demographics
NPI:1922213800
Name:EDMONDS, CARRIE HUDSON (LPC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:HUDSON
Last Name:EDMONDS
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 1:601 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-2105
Mailing Address - Country:US
Mailing Address - Phone:864-706-2265
Mailing Address - Fax:864-542-2324
Practice Address - Street 1:601 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2105
Practice Address - Country:US
Practice Address - Phone:864-706-2265
Practice Address - Fax:864-542-2324
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2692101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor