Provider Demographics
NPI:1396130134
Name:EDWARDS, CARMELITA
Entity type:Individual
Prefix:
First Name:CARMELITA
Middle Name:
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 1:123 N MAIN STREET
Mailing Address - Street 2:PO BOX 981
Mailing Address - City:RICH SQUARE
Mailing Address - State:NC
Mailing Address - Zip Code:27869
Mailing Address - Country:US
Mailing Address - Phone:252-287-3076
Mailing Address - Fax:
Practice Address - Street 1:123 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:RICH SQUARE
Practice Address - State:NC
Practice Address - Zip Code:27869
Practice Address - Country:US
Practice Address - Phone:252-287-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health