Provider Demographics
NPI:1932239829
Name:EDWARDS, CHARLENE (MA)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12111 HAWTHORNE WAY
Mailing Address - Street 2:#21
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3817
Mailing Address - Country:US
Mailing Address - Phone:323-309-9022
Mailing Address - Fax:
Practice Address - Street 1:12111 HAWTHORNE WAY
Practice Address - Street 2:#21
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3817
Practice Address - Country:US
Practice Address - Phone:323-309-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist