Active NPI
Christian Edwards
- Social Worker
- Southfield, MI
National Provider Identifier
1235722240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6851114263
- Practice address
- 17320 W 12 Mile Rd
Southfield, MI 48076-2100 - Phone
- (248) 727-3456
- NPI assigned
- Feb 19, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6851114263 | MI | Primary |
Addresses
Primary practice location
17320 W 12 Mile Rd
Southfield, MI 48076-2100
Mailing address
225 Vandalia Ave Apt 18B
Brooklyn, NY 11239-1416
Phone (347) 256-5051
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6851114263 | MI | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southfield Mental Health Associates PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Southfield, MI
- NPI 1619015872
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647216000000",
"number": "1235722240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "225 VANDALIA AVE APT 18B",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112391416",
"telephone_number": "347-256-5051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17320 W 12 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480762100",
"telephone_number": "248-727-3456"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "CHRISTIAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-19",
"last_updated": "2022-03-14",
"certification_date": "2022-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MI",
"license": "6851114263",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.