Active NPI
Andrew Wayne Edwards, LPC
- Mental Health Counselor
- Marietta, GA
National Provider Identifier
1295585354
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC012295
- Practice address
- 2689 Shadow Bluff Dr NE
Marietta, GA 30062-2567 - Phone
- (404) 783-2971
- NPI assigned
- Mar 22, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC012295 | GA | Primary |
Addresses
Primary practice location
2689 Shadow Bluff Dr NE
Marietta, GA 30062-2567
Mailing address
2689 Shadow Bluff Dr NE
Marietta, GA 30062-2567
Phone (404) 783-2971
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2024 through Apr 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC012295 | GA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711065600000",
"number": "1295585354",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2689 SHADOW BLUFF DR NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300622567",
"telephone_number": "404-783-2971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2689 SHADOW BLUFF DR NE",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300622567",
"telephone_number": "404-783-2971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "ANDREW",
"middle_name": "WAYNE",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-22",
"last_updated": "2024-03-22",
"certification_date": "2024-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "LPC012295",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.