Provider Demographics
NPI:1427858901
Name:EDWARDS, BONNIE (PPS)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 AUGUST WAY
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2402
Mailing Address - Country:US
Mailing Address - Phone:925-779-7415
Mailing Address - Fax:
Practice Address - Street 1:1310 AUGUST WAY
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2402
Practice Address - Country:US
Practice Address - Phone:925-779-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool