MEDICARE: MS. CYNTHIA DEE EDWARDS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C001012	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30091	OTHER	NC	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902886823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA DEE EDWARDS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 4776
Second Line	:
City	:	ARCHDALE
State	:	NC
Zip	:	27263-4776
Country	:	US
Telephone Number	:	336-431-1888
Fax Number	:	336-431-2217

Provider Business Practice Location Address
First Line	:	10547 N MAIN ST
Second Line	:	SUITE A
City	:	ARCHDALE
State	:	NC
Zip	:	27263-2883
Country	:	US
Telephone Number	:	336-431-1888
Fax Number	:	336-431-2217

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	02/18/2015

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