Active NPI
Theresa Edwards, PH.D.
- Psychologist
- Raleigh, NC
National Provider Identifier
1457375495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1532
- Practice address
- 8384 Six Forks Rd
Suite 104
Raleigh, NC 27615-5079 - Phone
- (919) 845-4550
- NPI assigned
- Jul 26, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1532 | NC | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1532 | NC | |
| School Psychologist | 103TS0200X | 1532 | NC |
Addresses
Primary practice location
8384 Six Forks Rd
Suite 104
Raleigh, NC 27615-5079
Mailing address
PO Box 98273
Raleigh, NC 27624-8273
Phone (919) 845-4550
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NONE | Other | NC | HEALTH SERVICES PROVIDER |
| 1532 | Other | NC | PSYCHOLOGY LICENSE |
| 0333A | Other | NC | BCBS PROVIDER # |
| 6000501 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1532 | NC | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389657600000",
"number": "1457375495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 98273",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276248273",
"telephone_number": "919-845-4550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8384 SIX FORKS RD",
"address_2": "SUITE 104",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276155079",
"telephone_number": "919-845-4550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "THERESA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-26",
"last_updated": "2014-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "1532",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "NC",
"license": "1532",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NC",
"license": "1532",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH SERVICES PROVIDER",
"identifier": "NONE",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE",
"identifier": "1532",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "0333A",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000501",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.