Provider Demographics
NPI:1427361955
Name:EDWARDS, AYESHA J (LCSW, BCD)
Entity Type:Individual
Prefix:MS
First Name:AYESHA
Middle Name:J
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL MEDICAL CENTER SAN DIEGO
Mailing Address - Street 2:34800 BOB WILSON DR, DMS SOCIAL WORK DEPARTMENT
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-5000
Mailing Address - Country:US
Mailing Address - Phone:619-453-4399
Mailing Address - Fax:
Practice Address - Street 1:2730 MCKEAN ST BLDG 291
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5000
Practice Address - Country:US
Practice Address - Phone:619-556-8449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-38861041C0700X
BCD-591391041C0700X
CA755521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical