Individual
TA-TANISHA ELAINE EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5215 COLLEY AVE, NORFOLK, VA 23508-2166
(757) 629-4352
Mailing address
5215 COLLEY AVE, NORFOLK, VA 23508-2166
(757) 629-4352
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
376905001
VA
Other
Enumeration date
08/20/2021
Last updated
08/20/2021
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