Provider Demographics
NPI:1356651186
Name:EDMONDSON, ROBERT JAMES JR (LCSWA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:EDMONDSON
Suffix:JR
Gender:M
Credentials:LCSWA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 759194
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9194
Mailing Address - Country:US
Mailing Address - Phone:540-710-6085
Mailing Address - Fax:540-710-6447
Practice Address - Street 1:1316 PATTON AVE
Practice Address - Street 2:D
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2666
Practice Address - Country:US
Practice Address - Phone:828-225-3100
Practice Address - Fax:828-225-3604
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2014-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
222Q00000X
NCP0090571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist