Provider Demographics
NPI:1407345663
Name:EDWARDS, KEVONYAH (LSW, LICDC)
Entity Type:Individual
Prefix:
First Name:KEVONYAH
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W 113TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8016
Mailing Address - Country:US
Mailing Address - Phone:513-237-8390
Mailing Address - Fax:
Practice Address - Street 1:954 W NORTH BEND RD STE 304B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2250
Practice Address - Country:US
Practice Address - Phone:513-237-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161852101YA0400X
OHLCDCIII.161445101YA0400X
OHS.19037031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)