Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 22196 | NY |
NPI | 1003219569 |
---|---|
Provider Name | Katrina Edwards |
First Address | Bronx, NY 10452-2016 |
Second Address | Bronx, NY 10452-2016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 29/09/2014 |