Doctor Name: | MR. JEFFREY A EDWARDS |
NPI Number: | 1376731000 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MDIV, CADC |
License Number: | A-8601-0001-A |
Business Practice Address: | 926 15th Ave East Moline, IL - 612442138 |
Business Phone Number: | 3097529740 |
Business Fax Number: | 3097529744 |
Mailing Address: | 926 15th Ave, EAST MOLINE |
State: | IL |
Postal Code: | 612442138 |
Phone Number: | 3097529740 |
Fax Number: | 3097529744 |
NPI Enumeration Date: | 10/09/2007 |
NPI Last Update Date: | 01/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | A-8601-0001-A |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |