Provider Demographics
NPI:1356072334
Name:URICH, EVELYN (CAP, ICADC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:URICH
Suffix:
Gender:F
Credentials:CAP, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 NE 53RD ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3235
Mailing Address - Country:US
Mailing Address - Phone:954-491-9700
Mailing Address - Fax:954-491-9710
Practice Address - Street 1:2331 NE 53RD ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3235
Practice Address - Country:US
Practice Address - Phone:954-491-9700
Practice Address - Fax:954-491-9710
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP100133101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)