Provider Demographics
NPI:1407937923
Name:EDWARDS, JAMESETTA (BFA)
Entity Type:Individual
Prefix:MS
First Name:JAMESETTA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:BFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 TRYON RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-2260
Mailing Address - Country:US
Mailing Address - Phone:708-228-3601
Mailing Address - Fax:219-875-3699
Practice Address - Street 1:5TH & ROOSEVELT
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:707-282-8387
Practice Address - Fax:708-202-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)