Individual
DR. THERESA EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
8384 SIX FORKS RD, SUITE 104, RALEIGH, NC 27615-5079
(919) 845-4550
Mailing address
PO BOX 98273, RALEIGH, NC 27624-8273
(919) 845-4550
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1532
NC
103TC2200X
Clinical Child & Adolescent Psychologist
1532
NC
103TS0200X
School Psychologist
1532
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0333A
BCBS PROVIDER #
NC
01
—
1532
PSYCHOLOGY LICENSE
NC
05
—
6000501
—
NC
01
—
NONE
HEALTH SERVICES PROVIDER
NC
Enumeration date
07/26/2006
Last updated
01/14/2014
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