Provider Demographics
NPI:1740684398
Name:EDWARDS, EMILY BLAIR (LCSW)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:BLAIR
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:BLAIR
Other - Last Name:HOLLIDAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:419 PINK CORAL LN
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5319
Mailing Address - Country:US
Mailing Address - Phone:407-765-4703
Mailing Address - Fax:
Practice Address - Street 1:118 1/2 N WOODLAND BLVD STE 3
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4268
Practice Address - Country:US
Practice Address - Phone:407-765-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW146921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical