Provider Demographics
NPI:1447619085
Name:EDWARDS, DIANA EVE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:EVE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 E RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2523
Mailing Address - Country:US
Mailing Address - Phone:602-248-9030
Mailing Address - Fax:602-248-3191
Practice Address - Street 1:1614 E RANCHO DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2523
Practice Address - Country:US
Practice Address - Phone:602-248-9030
Practice Address - Fax:602-248-3191
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1059103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling