Basic Information
| Provider Information | |||||||||
| NPI: | 1881257608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | ANGEL | ||||||||
| MiddleName: | CHARISSA | ||||||||
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| Credential: | LICENSE SOCIAL WORK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11505 PARKVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441045053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168343857 | ||||||||
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| Practice Location | |||||||||
| Address1: | 345 S HALCYON RD | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934203817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054894261 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2019 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | S30473 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.