Clinton Jamie Edwards, MA, M.ED, LCAS, CSI

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCAS-2133 Issued in NC

Practice address

1151 W Lebanon St Ste 200
Mount Airy, NC 27030-2225

Phone

(276) 728-6703

NPI assigned

May 7, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education, Master of Arts

State licenses

Practice roles

Locations

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.

• Cabin Village and Associates, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Mount Airy, NC
  • NPI 1194462747
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1376108191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6776 SNAKE CREEK RD",
            "city": "HILLSVILLE",
            "state": "VA",
            "postal_code": "243434586",
            "telephone_number": "276-728-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 W LEBANON ST STE 200",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270302225",
            "telephone_number": "276-728-6703"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3169 North Carolina Highway South",
            "address_purpose": "LOCATION",
            "city": "Walnut Cove",
            "state": "NC",
            "postal_code": "27052",
            "country_code": "US",
            "telephone_number": "336-306-4636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "CLINTON",
        "middle_name": "JAMIE",
        "name_prefix": "Mr.",
        "credential": "MA, M.ED, LCAS, CSI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-07",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-2133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Kay Easter, NP
• Sherrie Dawn Easter, CADC
• Eckerd Corporation
• Neil Lucas Edlen, PHARMD.
• Jason W Edsall, M.D.
• Regina Louise Edwards, BSW, MS, CRC, CCM
• Ica Draughn Eldridge, NC LMBT# 12464
• Susan Floyd Elium, PMHNP
• Milton Barry Ellis, MD
• Equality in Action

• Addiction (Substance Use Disorder) Counselor in Mount Airy, NC
• Providers in Mount Airy, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.

Verify at the official NPI Registry.