Provider Demographics
NPI:1124015920
Name:VEGA-EVANS, SARA MARGARITA (PSYCHOTHERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARGARITA
Last Name:VEGA-EVANS
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BROADVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-9657
Mailing Address - Country:US
Mailing Address - Phone:509-882-1158
Mailing Address - Fax:509-882-1158
Practice Address - Street 1:510 BROADVIEW DR
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-9657
Practice Address - Country:US
Practice Address - Phone:509-882-1158
Practice Address - Fax:509-882-1158
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA416194R101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor