Provider Demographics
NPI:1023762556
Name:EDWARDS, JAIME MARIE (SUDPT)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4109
Mailing Address - Country:US
Mailing Address - Phone:360-982-1682
Mailing Address - Fax:
Practice Address - Street 1:806 S VINE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7982
Practice Address - Country:US
Practice Address - Phone:360-452-2443
Practice Address - Fax:360-452-2738
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC061247586101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)