Provider Demographics
NPI:1972727477
Name:COUCH, EDITH KENNEDY (LPC NCC CFAE)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:KENNEDY
Last Name:COUCH
Suffix:
Gender:F
Credentials:LPC NCC CFAE
Other - Prefix:MRS
Other - First Name:EDITH
Other - Middle Name:KENNEDY
Other - Last Name:COUCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC NCC CFAE
Mailing Address - Street 1:1307 CHRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4661
Mailing Address - Country:US
Mailing Address - Phone:256-235-3799
Mailing Address - Fax:256-235-3709
Practice Address - Street 1:1307 CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4661
Practice Address - Country:US
Practice Address - Phone:256-235-3799
Practice Address - Fax:256-235-3709
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2077LPC101Y00000X
AL81231NCC101Y00000X
ALCFAE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor