Provider Demographics
NPI:1124252655
Name:EDWARDS, KARLA JEANNETTE
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:JEANNETTE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3910
Mailing Address - Country:US
Mailing Address - Phone:714-378-2620
Mailing Address - Fax:714-378-2631
Practice Address - Street 1:10101 SLATER AVE STE 241
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4723
Practice Address - Country:US
Practice Address - Phone:714-378-2620
Practice Address - Fax:714-378-2631
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW170691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical