Provider Demographics
NPI:1447324520
Name:POAGE, EDWIN DONALD (LPC LCDC)
Entity type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:DONALD
Last Name:POAGE
Suffix:
Gender:M
Credentials:LPC LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N GARFIELD
Mailing Address - Street 2:SUITE 230 HERITAGE COUNSELING
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705
Mailing Address - Country:US
Mailing Address - Phone:432-685-3787
Mailing Address - Fax:432-685-9998
Practice Address - Street 1:3000 N GARFIELD
Practice Address - Street 2:SUITE 230 HERITAGE COUNSELING
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705
Practice Address - Country:US
Practice Address - Phone:432-685-3787
Practice Address - Fax:432-685-9998
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3483101YA0400X
TXLPC14328103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist