Individual
CRYSTAL EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
903 W LINCOLN AVE, CHARLESTON, IL 61920-2413
(217) 348-8384
Mailing address
903 W LINCOLN AVE, CHARLESTON, IL 61920-2413
(217) 348-8384
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
34419
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
743113035
FEIN
IL
Enumeration date
02/07/2018
Last updated
02/07/2018
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