Provider Demographics
NPI:1336688902
Name:EVANS, JULIA (LCSW, CADC)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 GOVERNORS WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2178
Mailing Address - Country:US
Mailing Address - Phone:860-490-4010
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST
Practice Address - Street 2:#2036
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1708
Practice Address - Country:US
Practice Address - Phone:860-490-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32996101YA0400X
IL150.101987104100000X
IL1490193361041C0700X
CT0120961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker