Individual
SHAUWANNA NICOLE EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
504 BRICK KITCHEN RD, HOOKERTON, NC 28538-7010
(252) 525-3997
Mailing address
504 BRICK KITCHEN RD, HOOKERTON, NC 28538-7010
(252) 525-3997
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
311ZA0620X
Adult Care Home Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320700000X
Physical Disabilities Residential Treatment Facility
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
NC
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
01/02/2024
Last updated
01/02/2024
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