Provider Demographics
NPI:1497952154
Name:LIGONS, EVANGELINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EVANGELINA
Middle Name:
Last Name:LIGONS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:VANGIE
Other - Middle Name:
Other - Last Name:FANDINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:946 CALLE BRUSCA
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2327
Mailing Address - Country:US
Mailing Address - Phone:805-375-1368
Mailing Address - Fax:
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 1128104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCSW 1128OtherSOCIAL WORK