Provider Demographics
NPI:1376031765
Name:CONEY, EVELYN DONITA (BS)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:DONITA
Last Name:CONEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4427 EMERSON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4960
Mailing Address - Country:US
Mailing Address - Phone:904-398-7015
Mailing Address - Fax:904-346-0837
Practice Address - Street 1:4427 EMERSON ST STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4960
Practice Address - Country:US
Practice Address - Phone:904-398-7015
Practice Address - Fax:904-346-0837
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10093MMedicaid