Provider Demographics
NPI:1144958745
Name:EDWARDS, JAMIE MITCHELL (LCSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MITCHELL
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KY
Mailing Address - Zip Code:41002-1039
Mailing Address - Country:US
Mailing Address - Phone:502-550-5266
Mailing Address - Fax:
Practice Address - Street 1:119 S SHERRIN AVE STE 210
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3237
Practice Address - Country:US
Practice Address - Phone:502-550-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2568991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical