Provider Demographics
NPI:1003073032
Name:EVANS, SARA ELIZABETH CHERRY (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH CHERRY
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 E COOLEY DR
Mailing Address - Street 2:110
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3904
Mailing Address - Country:US
Mailing Address - Phone:909-580-0726
Mailing Address - Fax:
Practice Address - Street 1:1325 E COOLEY DR
Practice Address - Street 2:110
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3904
Practice Address - Country:US
Practice Address - Phone:909-580-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC45313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist