Doctor Name: | GLORIA EDGAR |
NPI Number: | 1023416377 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LPC007841 |
Business Practice Address: | 2709 Latley Bridge Rd Elko, GA - 310252326 |
Business Phone Number: | 4782860424 |
Business Fax Number: | |
Mailing Address: | 2709 Latley Bridge Rd, ELKO |
State: | GA |
Postal Code: | 310252326 |
Phone Number: | 4782860424 |
Fax Number: | |
NPI Enumeration Date: | 12/17/2014 |
NPI Last Update Date: | 12/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC007841 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |