Provider Demographics
NPI:1477024271
Name:SUDA, EVELYN H (MA)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:H
Last Name:SUDA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25126
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-5126
Mailing Address - Country:US
Mailing Address - Phone:671-988-4570
Mailing Address - Fax:
Practice Address - Street 1:222 CHALAN SANTO PAPA
Practice Address - Street 2:REFLECTION CENTER SUITE 102
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-472-0218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUIMF102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional