Provider Demographics
NPI:1730418575
Name:EDWARDS, DIANA SELSOR (PHD, LPCC)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:SELSOR
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-4509
Mailing Address - Country:US
Mailing Address - Phone:575-388-1258
Mailing Address - Fax:
Practice Address - Street 1:802 W 7TH ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4509
Practice Address - Country:US
Practice Address - Phone:575-388-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0125281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional