Doctor Name: | MISS AUTUMN ELYSE EDMISTON |
NPI Number: | 1013335140 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW, MSW |
License Number: | C009867 |
Business Practice Address: | 1601 Brenner Ave Salisbury, NC - 281442515 |
Business Phone Number: | 7046389000 |
Business Fax Number: | |
Mailing Address: | 210 Edmiston Ln, BOOMER |
State: | NC |
Postal Code: | 286068133 |
Phone Number: | 7046389000 |
Fax Number: | |
NPI Enumeration Date: | 04/05/2014 |
NPI Last Update Date: | 12/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | C009867 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |