Provider Demographics
NPI:1407435571
Name:EDWARDS, IEASHA DENISE (MA)
Entity Type:Individual
Prefix:
First Name:IEASHA
Middle Name:DENISE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6350
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-8045
Mailing Address - Country:US
Mailing Address - Phone:424-375-9983
Mailing Address - Fax:
Practice Address - Street 1:16379 E PRESERVE LOOP UNIT 1959
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91708-8898
Practice Address - Country:US
Practice Address - Phone:424-375-9983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist