Provider Demographics
NPI:1376242305
Name:EVANS, JOANIE (ASW)
Entity Type:Individual
Prefix:
First Name:JOANIE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:JOANIE
Other - Middle Name:
Other - Last Name:AYOADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1355 CALIFORNIA ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4971
Mailing Address - Country:US
Mailing Address - Phone:415-846-8620
Mailing Address - Fax:
Practice Address - Street 1:3301 E 12TH ST STE 259
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2940
Practice Address - Country:US
Practice Address - Phone:510-269-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA108675390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker