Provider Demographics
NPI:1437428596
Name:EDWARDS, ALANNA JEANNE (MA)
Entity Type:Individual
Prefix:
First Name:ALANNA
Middle Name:JEANNE
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 1:4321 TOMPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2820
Mailing Address - Country:US
Mailing Address - Phone:510-316-2016
Mailing Address - Fax:
Practice Address - Street 1:4321 TOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2820
Practice Address - Country:US
Practice Address - Phone:510-316-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 76187106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist