Provider Demographics
NPI:1992542716
Name:EDWARDS, DIANA CHIMA (MA, CADC)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:CHIMA
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, CADC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:CHIMA
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CADC
Mailing Address - Street 1:PO BOX 45280
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-8295
Mailing Address - Country:US
Mailing Address - Phone:215-720-2123
Mailing Address - Fax:
Practice Address - Street 1:5043 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2644
Practice Address - Country:US
Practice Address - Phone:215-744-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16690101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)