Provider Demographics
NPI:1093861965
Name:EVANS, CHARLOTTE L (MFT)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:L
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:2405 OLYMPIC DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1811
Mailing Address - Country:US
Mailing Address - Phone:661-399-9542
Mailing Address - Fax:
Practice Address - Street 1:1217 7TH ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1820
Practice Address - Country:US
Practice Address - Phone:661-758-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 20016174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist