Provider Demographics
NPI:1285427377
Name:THOMAS, EDWINA (PEER SUPPORT)
Entity type:Individual
Prefix:MS
First Name:EDWINA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 HORIZON AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2345
Mailing Address - Country:US
Mailing Address - Phone:909-808-5359
Mailing Address - Fax:
Practice Address - Street 1:604 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-3216
Practice Address - Country:US
Practice Address - Phone:909-746-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-YPIKXG175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist