Provider Demographics
NPI:1679749022
Name:EDWARDS, T AISHA (MS, LPC)
Entity type:Individual
Prefix:MISS
First Name:T
Middle Name:AISHA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E EVERGREEN BLVD
Mailing Address - Street 2:219B
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3129
Mailing Address - Country:US
Mailing Address - Phone:503-893-5931
Mailing Address - Fax:503-894-9745
Practice Address - Street 1:400 E EVERGREEN BLVD
Practice Address - Street 2:219B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3331
Practice Address - Country:US
Practice Address - Phone:503-893-5931
Practice Address - Fax:503-894-9745
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3146101YP2500X
WALH60435776101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional