Individual
LARISSA-JAYNE EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
10000 BAY PINES BLVD, BAY PINES, FL 33744-8200
(716) 867-5846
Mailing address
10000 BAY PINES BLVD, BAY PINES, FL 33744-8200
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
2177
AL
Other
Enumeration date
08/06/2020
Last updated
10/15/2021
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