Provider Demographics
NPI:1629504865
Name:EVANS, REBECCA (MAC, CDPT,CADCIII,)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MAC, CDPT,CADCIII,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9026 BIPLANE WAY
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4060
Mailing Address - Country:US
Mailing Address - Phone:916-388-9418
Mailing Address - Fax:
Practice Address - Street 1:7000 FRANKLIN BLVD STE 625
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-1884
Practice Address - Country:US
Practice Address - Phone:916-388-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-09
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60691835101YA0400X
OR16-01-03101YA0400X
OR511732101YA0400X
OR17-04-24101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR511732OtherNAADAC
CA9778OtherSUDCC
OR17-04-24OtherOREGON ADDICTION COUNSELOR CERTIFICATION BOARD