Provider Demographics
NPI:1881610673
Name:EDWARDS, HALISI JACQUELINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:HALISI
Middle Name:JACQUELINE
Last Name:EDWARDS
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 1:2616 OLD WESLEY CHAPEL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2367
Mailing Address - Country:US
Mailing Address - Phone:404-288-2826
Mailing Address - Fax:404-288-2556
Practice Address - Street 1:2616 OLD WESLEY CHAPEL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-2367
Practice Address - Country:US
Practice Address - Phone:404-288-2826
Practice Address - Fax:404-288-2556
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGQMMedicare ID - Type UnspecifiedPSYCHOLOGIST