Provider Demographics
NPI:1073199725
Name:EVANS, KERRI ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ANNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 KINGSLEY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4536
Mailing Address - Country:US
Mailing Address - Phone:904-214-3222
Mailing Address - Fax:904-621-9140
Practice Address - Street 1:1532 KINGSLEY AVE STE 112
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4536
Practice Address - Country:US
Practice Address - Phone:904-214-3222
Practice Address - Fax:904-621-9140
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW181361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical