Provider Demographics
NPI:1457073801
Name:ANDREA M. EDGMON, LCSW, PLLC
Entity Type:Organization
Organization Name:ANDREA M. EDGMON, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGMON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:479-214-0456
Mailing Address - Street 1:299 COUNTY ROAD 3299
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-8268
Mailing Address - Country:US
Mailing Address - Phone:479-214-0456
Mailing Address - Fax:
Practice Address - Street 1:313 S ROGERS ST STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3741
Practice Address - Country:US
Practice Address - Phone:479-388-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty