Provider Demographics
NPI:1760287858
Name:EDWARDS, EVIE MARIE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:EVIE
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:EVIE
Other - Middle Name:MARIE
Other - Last Name:BURLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11123 BALLET DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3500
Mailing Address - Country:US
Mailing Address - Phone:210-352-0832
Mailing Address - Fax:
Practice Address - Street 1:8000 WEST AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1837
Practice Address - Country:US
Practice Address - Phone:210-580-4149
Practice Address - Fax:325-267-7774
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health