Provider Demographics
NPI:1114122215
Name:EDWARDS COUNSELING ASSOCIATES, CORP
Entity Type:Organization
Organization Name:EDWARDS COUNSELING ASSOCIATES, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:904-448-1992
Mailing Address - Street 1:5991 CHESTER AVE
Mailing Address - Street 2:#104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2269
Mailing Address - Country:US
Mailing Address - Phone:904-448-1992
Mailing Address - Fax:904-448-8866
Practice Address - Street 1:5991 CHESTER AVE
Practice Address - Street 2:#104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2269
Practice Address - Country:US
Practice Address - Phone:904-448-1992
Practice Address - Fax:904-448-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSOW21851041C0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ135PMedicare PIN