Organization
T EDWARDS AND ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA EDWARDS PHD (OWNER)
(919) 845-4550
Entity
Organization
Contact information
Practice address
8394 SIX FORKS RD, STE 104, RALEIGH, NC 27615-3057
(919) 845-4550
(919) 845-2922
Mailing address
PO BOX 98273, RALEIGH, NC 27624-8273
(919) 845-4550
(919) 845-2922
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1532
NC
103TC2200X
Clinical Child & Adolescent Psychologist
1532
NC
103TF0000X
Family Psychologist
1532
NC
103TS0200X
School Psychologist
1532
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1532
LICENSE #
NC
05
—
6000501
—
NC
Enumeration date
09/28/2011
Last updated
09/28/2011
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