Individual
LISETTE CAROLA EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
12300 WASHINGTON HWY, ASHLAND, VA 23005-7646
(804) 365-4222
Mailing address
12300 WASHINGTON HWY, ASHLAND, VA 23005-7646
(804) 365-4222
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
07010008955
VA
101YP2500X
Professional Counselor
PCCI 3567
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104858653
—
VA
Enumeration date
12/27/2016
Last updated
04/13/2020
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