Provider Demographics
NPI:1124781695
Name:EDWARDS, SANDRA L (LCAS-A)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 PLATTE XING UNIT 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-9301
Mailing Address - Country:US
Mailing Address - Phone:919-525-9110
Mailing Address - Fax:
Practice Address - Street 1:10010 PLATTE XING UNIT 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-9301
Practice Address - Country:US
Practice Address - Phone:919-525-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)