Basic Information
| Provider Information | |||||||||
| NPI: | 1912027558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | TONA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LADC-CCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 ESSEX ST | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044015372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079454240 | ||||||||
| FaxNumber: | 2079903660 | ||||||||
| Practice Location | |||||||||
| Address1: | 970 ILLINOIS AVE | ||||||||
| Address2: | |||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044012722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079454240 | ||||||||
| FaxNumber: | 2079903660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 08/02/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LC 1492 | ME | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YS0200X | LC 1492 | ME | N | Behavioral Health & Social Service Providers | Counselor | School |
No ID Information.