Provider Demographics
NPI:1497259428
Name:EDWARDS, ANN (QMHS, CDCA, LPC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:QMHS, CDCA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1122
Mailing Address - Country:US
Mailing Address - Phone:937-496-2000
Mailing Address - Fax:
Practice Address - Street 1:600 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-1122
Practice Address - Country:US
Practice Address - Phone:937-496-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHC.2103304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator