Provider Demographics
NPI:1013785393
Name:EDWARDS, MAYA MARIA
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:MARIA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 BIENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-5321
Mailing Address - Country:US
Mailing Address - Phone:504-486-8002
Mailing Address - Fax:504-486-8020
Practice Address - Street 1:3400 BIENVILLE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5321
Practice Address - Country:US
Practice Address - Phone:504-486-8002
Practice Address - Fax:504-486-8020
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15422101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool