Provider Demographics
NPI:1801133350
Name:EDWARDS, JOHN WAYNE (NCC, LPC, LMFT, LCAS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WAYNE
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:NCC, LPC, LMFT, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 S BRAGG BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-3929
Mailing Address - Country:US
Mailing Address - Phone:910-916-7881
Mailing Address - Fax:910-436-5343
Practice Address - Street 1:242 S BRAGG BLVD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3929
Practice Address - Country:US
Practice Address - Phone:910-916-7881
Practice Address - Fax:910-436-5343
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20174101YA0400X
NC9504101YM0800X
NC1501106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health