Provider Demographics
NPI:1568520245
Name:EDWARDS, JAMES DOUGLAS (DOUG) (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DOUGLAS (DOUG)
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 KILARNEY CT
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-2985
Mailing Address - Country:US
Mailing Address - Phone:217-433-6109
Mailing Address - Fax:
Practice Address - Street 1:1213 CULBRETH DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3639
Practice Address - Country:US
Practice Address - Phone:217-433-6109
Practice Address - Fax:910-386-4523
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0066561041C0700X
NCC0098031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC009803OtherNORTH CAROLINA STATE LICENSURE
IL149-006656OtherSOCIAL WORK LICENSE