Provider Demographics
NPI:1346974375
Name:EDWARDS, MITCHELL (CADC)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 KURT CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2806
Mailing Address - Country:US
Mailing Address - Phone:704-965-6300
Mailing Address - Fax:
Practice Address - Street 1:508 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1421
Practice Address - Country:US
Practice Address - Phone:704-248-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC81-1600590Medicaid