Healthcare Provider Details

I. General information

NPI: 1144714791
Provider Name (Legal Business Name): ROSELLA KIM EDWARDS-EASLEY LCAS, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSELLA KIM EDWARDS- EASLEY LCMHC, LCAS

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 N POINT BLVD # 244
WINSTON SALEM NC
27106-3262
US

IV. Provider business mailing address

8025 N POINT BLVD # 244
WINSTON SALEM NC
27106-3262
US

V. Phone/Fax

Practice location:
  • Phone: 336-306-9198
  • Fax: 336-450-1809
Mailing address:
  • Phone: 336-306-9198
  • Fax: 336-450-1809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14670
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-24307
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14670
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: