Provider Demographics
NPI:1669774824
Name:EDWARDS ASSESSMENTS AND COUNSELING, INC.
Entity type:Organization
Organization Name:EDWARDS ASSESSMENTS AND COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:PRUDEN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS, ACSW
Authorized Official - Phone:252-535-1070
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NC
Mailing Address - Zip Code:27845-0475
Mailing Address - Country:US
Mailing Address - Phone:252-535-1070
Mailing Address - Fax:252-535-1090
Practice Address - Street 1:321 NC HIGHWAY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6445
Practice Address - Country:US
Practice Address - Phone:252-535-1070
Practice Address - Fax:252-535-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-21
Last Update Date:2010-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC483101YA0400X
NC4018101YP2500X
NCC0062741041C0700X
NCCOOO5531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005473Medicaid