Provider Demographics
NPI:1942626122
Name:EDWARDS, CARLTON
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 VIA VISIONE
Mailing Address - Street 2:UNIT 102
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-3699
Mailing Address - Country:US
Mailing Address - Phone:214-417-0681
Mailing Address - Fax:
Practice Address - Street 1:23 VIA VISIONE
Practice Address - Street 2:UNIT 102
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-3699
Practice Address - Country:US
Practice Address - Phone:214-417-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor