Provider Demographics
NPI:1538374004
Name:EDWARDS, RALPH (MSW)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3524
Mailing Address - Country:US
Mailing Address - Phone:810-767-7293
Mailing Address - Fax:
Practice Address - Street 1:7508 M E CAD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4281
Practice Address - Country:US
Practice Address - Phone:248-922-9200
Practice Address - Fax:248-922-9700
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801062495104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1851517973OtherCORPORATE NPI