Provider Demographics
NPI:1801228770
Name:EVANS, CHARLOTTE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 555
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6751
Mailing Address - Country:US
Mailing Address - Phone:954-297-5077
Mailing Address - Fax:
Practice Address - Street 1:4000 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 555
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6751
Practice Address - Country:US
Practice Address - Phone:954-297-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7704104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker