Provider Demographics
NPI:1922360973
Name:EDWARDS, CARLA MARIE (PHD, LAC, DIPL O)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PHD, LAC, DIPL O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 GREENWOOD ST
Mailing Address - Street 2:UNIT 105
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3979
Mailing Address - Country:US
Mailing Address - Phone:847-525-1309
Mailing Address - Fax:847-859-6100
Practice Address - Street 1:1601 SHERMAN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-525-1309
Practice Address - Fax:847-859-6100
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000601171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist