Derenda Denise Edmondson

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH7310 Issued in FL

Practice address

9951 Atlantic Blvd
Suite 126
Jacksonville, FL 32225-6584

Phone

(904) 724-9960

Fax

(904) 714-0566

NPI assigned

Nov 1, 2006

Reactivated

Jul 9, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1831276682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9951 ATLANTIC BLVD",
            "address_2": "SUITE 126",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322256584",
            "telephone_number": "904-724-9960",
            "fax_number": "904-714-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9951 ATLANTIC BLVD",
            "address_2": "SUITE 126",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322256584",
            "telephone_number": "904-724-9960",
            "fax_number": "904-714-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMONDSON",
        "first_name": "DERENDA",
        "middle_name": "DENISE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2019-07-09",
        "deactivation_date": "2019-07-01",
        "reactivation_date": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH7310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathon Curtis Edgy, MD
• Peter Ediagbonya, RPH
• Stefanie Ann Edinger, PHARMD
• Teresa A. Edison, ARNP
• Michelle L Edmonds, M.D.
• Eduardo a. Sanchez, M.D., P.a.
• Edward a Maybury MD PA
• Edward C. Taylor, PHD. PL
• Edward C. Taylor, PHD. PL
• Edward J Wetzork DC PA

• Mental Health Counselor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.