Provider Demographics
NPI:1568116994
Name:EVERETT, CHRISTOL EVEONNE (CDCA)
Entity Type:Individual
Prefix:MS
First Name:CHRISTOL
Middle Name:EVEONNE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 STUCKHARDT RD
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-2756
Mailing Address - Country:US
Mailing Address - Phone:937-979-3485
Mailing Address - Fax:
Practice Address - Street 1:5 STUCKHARDT RD
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2756
Practice Address - Country:US
Practice Address - Phone:937-979-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.179436101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)