Provider Demographics
NPI:1225420615
Name:EVANS, CRISTIN (LADC)
Entity Type:Individual
Prefix:
First Name:CRISTIN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2528
Mailing Address - Country:US
Mailing Address - Phone:218-751-3280
Mailing Address - Fax:218-751-3298
Practice Address - Street 1:403 4TH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-444-5155
Practice Address - Fax:218-333-3921
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303931101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)