Provider Demographics
NPI:1649581216
Name:EVANS, PATRICIA ANN (LCADC-S)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCADC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 N RILEY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4124
Mailing Address - Country:US
Mailing Address - Phone:619-646-8699
Mailing Address - Fax:725-502-2396
Practice Address - Street 1:4845 N RILEY ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4124
Practice Address - Country:US
Practice Address - Phone:619-647-8699
Practice Address - Fax:725-502-2396
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48187106H00000X
NV07069-LCS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist