Provider Demographics
NPI:1831217116
Name:EDENS, ANNE WYNNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:WYNNE
Last Name:EDENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 MEDICAL PLAZA DR.
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-797-3636
Mailing Address - Fax:843-797-3637
Practice Address - Street 1:2962 MEDICAL PLAZA DR.
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-797-3636
Practice Address - Fax:843-797-3637
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1563103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000758469-AMedicaid