Provider Demographics
NPI:1184792798
Name:EDWARDS, JAMES BURNSIDES (LPC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BURNSIDES
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11749 COUNTY ROAD 49
Mailing Address - Street 2:
Mailing Address - City:HEFLIN
Mailing Address - State:AL
Mailing Address - Zip Code:36264-5115
Mailing Address - Country:US
Mailing Address - Phone:256-748-2416
Mailing Address - Fax:
Practice Address - Street 1:331 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5731
Practice Address - Country:US
Practice Address - Phone:256-236-3403
Practice Address - Fax:256-238-6263
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL41646OtherBLUE CROSS