Provider Demographics
NPI:1952476152
Name:EDWARDS, GEORGE KEVIN (MA LPA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:KEVIN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MA LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 ARBOR RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451
Mailing Address - Country:US
Mailing Address - Phone:910-409-2758
Mailing Address - Fax:
Practice Address - Street 1:2250 SHIPYARD BLVD SUITE 3
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412
Practice Address - Country:US
Practice Address - Phone:910-791-9625
Practice Address - Fax:910-792-9799
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2391103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136MCOtherBCBS
NC2875996Medicaid
NC2875996Medicaid