Provider Demographics
NPI:1952859480
Name:HARGROVE EDWARDS, ARETHA (EDD, LPC-S, ACS,ETC)
Entity Type:Individual
Prefix:DR
First Name:ARETHA
Middle Name:
Last Name:HARGROVE EDWARDS
Suffix:
Gender:F
Credentials:EDD, LPC-S, ACS,ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4851
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-4851
Mailing Address - Country:US
Mailing Address - Phone:662-931-0287
Mailing Address - Fax:
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701
Practice Address - Country:US
Practice Address - Phone:662-347-7229
Practice Address - Fax:662-332-7225
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional