Provider Demographics
NPI:1568934164
Name:EVANS-WINTERS, VENUS E (LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:VENUS
Middle Name:E
Last Name:EVANS-WINTERS
Suffix:
Gender:F
Credentials:LCSW, PHD
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 9401
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-9401
Mailing Address - Country:US
Mailing Address - Phone:309-453-0953
Mailing Address - Fax:
Practice Address - Street 1:4507 N STERLING AVE STE 201
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3861
Practice Address - Country:US
Practice Address - Phone:309-362-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490198061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical