Provider Demographics
NPI:1760503031
Name:EDWARDS, BRENDA (LCSW)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2129 TUDOR CASTLE WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2165
Mailing Address - Country:US
Mailing Address - Phone:678-570-6698
Mailing Address - Fax:
Practice Address - Street 1:2129 TUDOR CASTLE WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2165
Practice Address - Country:US
Practice Address - Phone:678-570-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0007481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical