Individual
TANYA M EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
248 E CAPITOL ST, JACKSON, MS 39201-2503
(800) 632-6074
Mailing address
501 AVALON WAY, STE D, BRANDON, MS 39047-7500
(601) 951-9863
(601) 362-4061
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C7486
MS
Other
Enumeration date
02/04/2009
Last updated
09/03/2019
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