Provider Demographics
NPI:1366507634
Name:EVANS, ANGELA L (MA, LCPC, CADC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 W PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-2008
Mailing Address - Country:US
Mailing Address - Phone:217-827-0737
Mailing Address - Fax:
Practice Address - Street 1:1029 W PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-2008
Practice Address - Country:US
Practice Address - Phone:217-827-0737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional