Provider Demographics
NPI:1720413776
Name:EVANS, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
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 1:555 31ST ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-1422
Mailing Address - Country:US
Mailing Address - Phone:727-209-2456
Mailing Address - Fax:727-209-0297
Practice Address - Street 1:555 31ST ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1422
Practice Address - Country:US
Practice Address - Phone:727-209-2456
Practice Address - Fax:727-209-0297
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1356OtherCERTIFIED BEHAVIORAL HEALTH TECHNICIAN