Provider Demographics
NPI:1053155366
Name:CARMON, EDWARD (CAC-I)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:CARMON
Suffix:
Gender:M
Credentials:CAC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 2ND ST NW # 2N
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2003
Mailing Address - Country:US
Mailing Address - Phone:202-783-7343
Mailing Address - Fax:202-347-5476
Practice Address - Street 1:425 2ND ST NW # 2N
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2003
Practice Address - Country:US
Practice Address - Phone:202-783-7343
Practice Address - Fax:202-347-5476
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACI1039101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)