Provider Demographics
NPI:1710852470
Name:EDWARDS, LORALYN (LAC)
Entity type:Individual
Prefix:
First Name:LORALYN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 ASHLAND RD
Mailing Address - Street 2:BUILDING-A, SUITE #40
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210
Mailing Address - Country:US
Mailing Address - Phone:803-528-8844
Mailing Address - Fax:
Practice Address - Street 1:2821 ASHLAND RD
Practice Address - Street 2:BUILDING-A, SUITE #40
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210
Practice Address - Country:US
Practice Address - Phone:803-528-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCACU-112171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist