Provider Demographics
NPI:1679722540
Name:EDWARDS, SARAH ANNE (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ANNE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6775
Mailing Address - Street 2:
Mailing Address - City:FRAZIER PARK
Mailing Address - State:CA
Mailing Address - Zip Code:93222-6775
Mailing Address - Country:US
Mailing Address - Phone:661-242-2624
Mailing Address - Fax:661-242-1492
Practice Address - Street 1:2624 TEAKWOOD COURT
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN CLUB
Practice Address - State:CA
Practice Address - Zip Code:93222-6775
Practice Address - Country:US
Practice Address - Phone:661-242-2624
Practice Address - Fax:661-242-1492
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical