Provider Demographics
NPI:1811426968
Name:EDWARDS, CYNTHIA JUNE (LCSW, LASOP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:JUNE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:LCSW, LASOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S EUGENE LN
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1554
Mailing Address - Country:US
Mailing Address - Phone:618-889-5140
Mailing Address - Fax:
Practice Address - Street 1:1257 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5002
Practice Address - Country:US
Practice Address - Phone:618-351-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-11
Last Update Date:2017-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0188841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical