Provider Demographics
NPI:1720458672
Name:EDWARDS, ALICIA (LLBSW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIVER PLACE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4274
Mailing Address - Country:US
Mailing Address - Phone:313-871-2337
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER PLACE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4274
Practice Address - Country:US
Practice Address - Phone:313-871-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020886591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical