Provider Demographics
NPI:1417133232
Name:EDWARDS, BOBBY LOUIS (RSAI, RCAS)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:LOUIS
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:RSAI, RCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 MACARTHUR BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5260
Mailing Address - Country:US
Mailing Address - Phone:510-568-2432
Mailing Address - Fax:510-568-2971
Practice Address - Street 1:10700 MACARTHUR BLVD STE 12
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-5260
Practice Address - Country:US
Practice Address - Phone:510-568-2432
Practice Address - Fax:510-568-2971
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-E0507181308101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor