Provider Demographics
NPI:1639856826
Name:EVANS, ALISSA CLAIRE
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:CLAIRE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 STUART ST APT E
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2229
Mailing Address - Country:US
Mailing Address - Phone:619-490-6313
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 125D
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2424
Practice Address - Country:US
Practice Address - Phone:510-777-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical