Provider Demographics
NPI:1639410525
Name:EVANS, JACQUELINE ROSE (LCSW, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ROSE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:ROSE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCADC
Mailing Address - Street 1:3211 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1953
Mailing Address - Country:US
Mailing Address - Phone:702-871-3730
Mailing Address - Fax:702-922-6600
Practice Address - Street 1:3211 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1953
Practice Address - Country:US
Practice Address - Phone:702-871-3730
Practice Address - Fax:702-922-6600
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-03
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00302-C101YA0400X
NV6304-S104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)