Provider Demographics
NPI:1073852869
Name:EDWARDS, BONNIE (PCC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BLUE LINE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2325
Mailing Address - Country:US
Mailing Address - Phone:740-592-5689
Mailing Address - Fax:740-593-7166
Practice Address - Street 1:17 BLUE LINE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2325
Practice Address - Country:US
Practice Address - Phone:740-592-5689
Practice Address - Fax:740-593-7166
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 0005332101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional