Provider Demographics
NPI:1205185964
Name:WILLIAMS, EVANGELINE CHRISTINE (MA)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:CHRISTINE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2237
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91610-0237
Mailing Address - Country:US
Mailing Address - Phone:949-280-0292
Mailing Address - Fax:
Practice Address - Street 1:2116 ARLINGTON AVE
Practice Address - Street 2:STE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1353
Practice Address - Country:US
Practice Address - Phone:949-280-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-09
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI98036106H00000X
CAMFTI53357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health