Provider Demographics
NPI:1689231094
Name:EDWARDS, CHASITY (SUDC, NCAC II)
Entity Type:Individual
Prefix:MRS
First Name:CHASITY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:SUDC, NCAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 ALAMOSA DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-8109
Mailing Address - Country:US
Mailing Address - Phone:435-669-3142
Mailing Address - Fax:
Practice Address - Street 1:491 E RIVERSIDE DR STE 1A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7052
Practice Address - Country:US
Practice Address - Phone:435-703-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8196340-6006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)