Provider Demographics
NPI:1780332452
Name:SIDEBOTTOM, EDWARD WATERS (LPC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:WATERS
Last Name:SIDEBOTTOM
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 1:5372 WINDY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-7359
Mailing Address - Country:US
Mailing Address - Phone:434-981-2351
Mailing Address - Fax:
Practice Address - Street 1:5372 WINDY RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-7359
Practice Address - Country:US
Practice Address - Phone:434-981-2351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health