Individual
EDWINA DENISE POLK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
10130 MALLARD CREEK RD STE 300, CHARLOTTE, NC 28262-6001
(704) 320-8766
Mailing address
4514 AUSTIN DEKOTA DR, CHARLOTTE, NC 28269-2156
(704) 320-8766
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
11379
NC
101YM0800X
Mental Health Counselor
11379
NC
Other
Enumeration date
06/20/2019
Last updated
06/20/2019
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