Provider Demographics
NPI:1255909297
Name:EDWARDS, RAINA (LMHC)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 NE 121ST ST APT 501
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6551
Mailing Address - Country:US
Mailing Address - Phone:585-955-3553
Mailing Address - Fax:
Practice Address - Street 1:1920 E HALLANDALE BEACH BLVD STE 640
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4707
Practice Address - Country:US
Practice Address - Phone:954-367-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health