Provider Demographics
NPI:1225209802
Name:ADULT & ADOLESCENT COUNSELING
Entity Type:Organization
Organization Name:ADULT & ADOLESCENT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-870-8100
Mailing Address - Street 1:2630 NW 41ST ST STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6666
Mailing Address - Country:US
Mailing Address - Phone:352-870-8100
Mailing Address - Fax:352-548-4998
Practice Address - Street 1:2630 NW 41ST ST STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6666
Practice Address - Country:US
Practice Address - Phone:352-870-8100
Practice Address - Fax:352-548-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6848101YA0400X
FLMH 6848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty