Provider Demographics
NPI:1942847355
Name:EDWARDS, AMBER (MA, LCDC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15440
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-8640
Mailing Address - Country:US
Mailing Address - Phone:210-785-3040
Mailing Address - Fax:
Practice Address - Street 1:419 E MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3012
Practice Address - Country:US
Practice Address - Phone:210-785-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)