Individual
IMMANUEL TREY EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1110 13TH ST UNIT D, COLUMBUS, GA 31901-2246
(706) 254-9342
Mailing address
1110 13TH ST UNIT D, COLUMBUS, GA 31901-2246
(708) 780-1704
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-77058
GA
106E00000X
Assistant Behavior Analyst
0-24-14986
GA
106S00000X
Behavior Technician
—
—
Other
Enumeration date
02/09/2022
Last updated
11/13/2024
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