Provider Demographics
NPI:1649470857
Name:BARCLAY, EDWINA M (CADC)
Entity type:Individual
Prefix:MS
First Name:EDWINA
Middle Name:M
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7902 GERBER RD
Mailing Address - Street 2:PMB #352
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-4352
Mailing Address - Country:US
Mailing Address - Phone:916-968-8503
Mailing Address - Fax:
Practice Address - Street 1:7225 E SOUTHGATE DR
Practice Address - Street 2:SUITE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2652
Practice Address - Country:US
Practice Address - Phone:916-394-1000
Practice Address - Fax:916-394-1010
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC032980315101YA0400X
CAB0704012240101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)