Provider Demographics
NPI:1982828158
Name:EDWARDS, LEON RENNODA (BSW, MSSW, DS)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:RENNODA
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:BSW, MSSW, DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 PINEVIEW ROAD APT #103
Mailing Address - Street 2:APT #103
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125
Mailing Address - Country:US
Mailing Address - Phone:901-229-6565
Mailing Address - Fax:
Practice Address - Street 1:3585 AUSTIN PEAY HWY SUITE #112
Practice Address - Street 2:SUITE 112
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128
Practice Address - Country:US
Practice Address - Phone:901-229-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN5504-LCSW1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical