Basic Information
| Provider Information | |||||||||
| NPI: | 1003356908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | MEEKS | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 N 11TH ST | ||||||||
| Address2: | STEPHEN & SANDRA SHELLER 11TH STREET FAMILY HEALTH SERV | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191231957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157691115 | ||||||||
| FaxNumber: | 2157691117 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 N 11TH ST | ||||||||
| Address2: | STEPHEN & SANDRA SHELLER 11TH STREET FAMILY HEALTH SERV | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191231957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157691115 | ||||||||
| FaxNumber: | 2157691117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2017 | ||||||||
| LastUpdateDate: | 02/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PC007770 | PA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.