Provider Demographics
NPI:1902055171
Name:EDWARDS, AMY SNYDER (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SNYDER
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2149
Mailing Address - Country:US
Mailing Address - Phone:304-926-8600
Mailing Address - Fax:304-926-8605
Practice Address - Street 1:5130 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2149
Practice Address - Country:US
Practice Address - Phone:304-926-8600
Practice Address - Fax:304-926-8605
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1903101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional