Doctor Name: | JANET M EDMONDS |
NPI Number: | 1174968978 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | COUNSELOR CAS, RAS |
License Number: | CAS 03-108316 |
Business Practice Address: | 7000b S Center Dr Clearlake, CA - 954228131 |
Business Phone Number: | 7070994709 |
Business Fax Number: | |
Mailing Address: | 7000b S Center Dr, CLEARLAKE |
State: | CA |
Postal Code: | 954228131 |
Phone Number: | 7079947090 |
Fax Number: | |
NPI Enumeration Date: | 05/07/2013 |
NPI Last Update Date: | 07/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CAS 03-108316 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |