Provider Demographics
NPI:1376040063
Name:EDMONDSON, YVONNEDA WINIFRED-ROSE (CDCA II)
Entity type:Individual
Prefix:MS
First Name:YVONNEDA
Middle Name:WINIFRED-ROSE
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:CDCA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 PROSPECT AVE E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2706
Mailing Address - Country:US
Mailing Address - Phone:216-391-6672
Mailing Address - Fax:
Practice Address - Street 1:2475 N TAYLOR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-1344
Practice Address - Country:US
Practice Address - Phone:216-600-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH165667101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)