Provider Demographics
NPI:1043682818
Name:THERESA LUCILLE EVANS KNIGHT MA LMFT LLC
Entity Type:Organization
Organization Name:THERESA LUCILLE EVANS KNIGHT MA LMFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LUCILLE EVANS
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:203-722-3312
Mailing Address - Street 1:37 CRANBURY RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-2616
Mailing Address - Country:US
Mailing Address - Phone:203-722-3312
Mailing Address - Fax:203-849-3230
Practice Address - Street 1:37 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-2616
Practice Address - Country:US
Practice Address - Phone:203-722-3312
Practice Address - Fax:203-849-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001731251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00806011Medicaid