Provider Demographics
NPI:1821238684
Name:EDWARDS, DIANE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7586 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-3923
Mailing Address - Country:US
Mailing Address - Phone:916-405-4600
Mailing Address - Fax:916-405-4620
Practice Address - Street 1:7586 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-3923
Practice Address - Country:US
Practice Address - Phone:916-405-4600
Practice Address - Fax:916-405-4620
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)