Provider Demographics
NPI:1881056141
Name:EDWARDS, CAROLYN YVONNE
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:YVONNE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:YVONNE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13116 SE 306TH PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3406
Mailing Address - Country:US
Mailing Address - Phone:808-371-3165
Mailing Address - Fax:
Practice Address - Street 1:309 E MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5540
Practice Address - Country:US
Practice Address - Phone:808-371-3165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60983439101YM0800X
WACG60637119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health