Provider Demographics
NPI:1851447106
Name:EDWARDS, JOHN BENJAMIN (MSW, ACSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BENJAMIN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MSW, ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-5009
Mailing Address - Country:US
Mailing Address - Phone:252-823-2927
Mailing Address - Fax:252-823-8792
Practice Address - Street 1:325 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5009
Practice Address - Country:US
Practice Address - Phone:252-823-2927
Practice Address - Fax:252-823-8792
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC000554104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC53901OtherCIGNA
NC131UROtherBLUECROSSBLUESHIELD
NC6002083Medicaid
NC53901OtherCIGNA