Provider Demographics
NPI:1760682207
Name:EVANS, DONA CECELIA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DONA
Middle Name:CECELIA
Last Name:EVANS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 CEDAR AVE. SOUTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-4733
Mailing Address - Country:US
Mailing Address - Phone:612-724-4212
Mailing Address - Fax:612-825-6666
Practice Address - Street 1:3111 1ST AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3136
Practice Address - Country:US
Practice Address - Phone:612-767-6652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-31157OtherUNITED BEHAVIORAL HEALTH