Provider Demographics
NPI:1952877995
Name:CANADA, EDWARD GAHAM III (LPC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:GAHAM
Last Name:CANADA
Suffix:III
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 1:4191 INNSLAKE DR STE 211
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3324
Mailing Address - Country:US
Mailing Address - Phone:804-303-9622
Mailing Address - Fax:
Practice Address - Street 1:4191 INNSLAKE DR STE 211
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3324
Practice Address - Country:US
Practice Address - Phone:804-303-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health