Provider Demographics
NPI:1497961296
Name:EDWARDS, NATALIE I (PCCS, CDCA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:I
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PCCS, CDCA
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:I
Other - Last Name:BONCHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1206 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-1926
Mailing Address - Country:US
Mailing Address - Phone:330-361-0965
Mailing Address - Fax:
Practice Address - Street 1:1206 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1926
Practice Address - Country:US
Practice Address - Phone:330-361-0965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0601006101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3121848Medicaid