Provider Demographics
NPI:1376027839
Name:EDWARDS, ERIK SHANE JR (BS, QMHS)
Entity Type:Individual
Prefix:MR
First Name:ERIK
Middle Name:SHANE
Last Name:EDWARDS
Suffix:JR
Gender:M
Credentials:BS, QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1745
Mailing Address - Country:US
Mailing Address - Phone:513-621-1117
Mailing Address - Fax:
Practice Address - Street 1:2347 VINE ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1745
Practice Address - Country:US
Practice Address - Phone:513-621-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator