Provider Demographics
NPI:1679709232
Name:EVANS, LYNDA CONNIE (MSW, ASW, RAS)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:CONNIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW, ASW, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1833
Mailing Address - Country:US
Mailing Address - Phone:213-241-0979
Mailing Address - Fax:213-202-3977
Practice Address - Street 1:1125 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1833
Practice Address - Country:US
Practice Address - Phone:213-241-0979
Practice Address - Fax:213-202-3977
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
CAASW599391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)