Provider Demographics
NPI:1487844387
Name:EDMONDS, CHRIS L (MSW, CMSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:L
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:MSW, CMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LARCHMONT RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-0875
Mailing Address - Country:US
Mailing Address - Phone:910-308-1126
Mailing Address - Fax:910-482-3877
Practice Address - Street 1:237 LARCHMONT RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-0875
Practice Address - Country:US
Practice Address - Phone:910-308-1126
Practice Address - Fax:910-482-3877
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0057411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical