Provider Demographics
NPI:1891065686
Name:EDWARDS, BOBBIE (BCBA, MS)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:BCBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:
Practice Address - Street 1:200 RIDGEFIELD CT STE 204
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2337
Practice Address - Country:US
Practice Address - Phone:828-367-9979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1052211103K00000X
103K00000X
NC1-05-2211103K00000X
TX1-05-2211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1-05-2211OtherBEHAVIOR ANALYST CERTIFICATION BOARD
TX1-05-2211OtherBCBA