Provider Demographics
NPI:1629272984
Name:DE VILLIERS, EVELYN ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ANNE
Last Name:DE VILLIERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9255 TOWNE CENTRE DR
Mailing Address - Street 2:SUITE 875
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3033
Mailing Address - Country:US
Mailing Address - Phone:858-824-9458
Mailing Address - Fax:858-455-5556
Practice Address - Street 1:153 PIONEER LN STE B
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2517
Practice Address - Country:US
Practice Address - Phone:760-873-2849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical