Provider Demographics
NPI:1972239986
Name:EDMONDS, CHRISTOPHER (R1476250722)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:R1476250722
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N D ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-3524
Mailing Address - Country:US
Mailing Address - Phone:619-586-4930
Mailing Address - Fax:
Practice Address - Street 1:9826 18TH AVE
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-9229
Practice Address - Country:US
Practice Address - Phone:619-586-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)