Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | I2691207 | CA |
NPI | 1003186743 |
---|---|
Provider Name | Elena Louise Edwards |
First Address | Orange, CA 92868-4712 |
Second Address | Orange, CA 92868-4712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 11/01/2012 |