Provider Demographics
NPI:1477527091
Name:EVANS, CRICKET C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CRICKET
Middle Name:C
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 N STATE ROAD 434
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2172
Mailing Address - Country:US
Mailing Address - Phone:407-862-2662
Mailing Address - Fax:407-862-2880
Practice Address - Street 1:498 N STATE ROAD 434
Practice Address - Street 2:SUITE B
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2172
Practice Address - Country:US
Practice Address - Phone:407-862-2662
Practice Address - Fax:407-862-2880
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical