Doctor Name: | MR. EDWARD E SCUDDER |
NPI Number: | 1063661510 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | LPC003114 |
Business Practice Address: | 615 Windy Hill Rd Griffin, GA - 302245330 |
Business Phone Number: | 7702283156 |
Business Fax Number: | |
Mailing Address: | 615 Windy Hill Rd, GRIFFIN |
State: | GA |
Postal Code: | 302245330 |
Phone Number: | 7702283156 |
Fax Number: | |
NPI Enumeration Date: | 09/09/2008 |
NPI Last Update Date: | 09/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC003114 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |