Provider Demographics
NPI:1821349556
Name:EVERAERTS, ABBY MARIE (PSYD, MS)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:MARIE
Last Name:EVERAERTS
Suffix:
Gender:F
Credentials:PSYD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 NE 7TH AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-4599
Mailing Address - Country:US
Mailing Address - Phone:360-574-9565
Mailing Address - Fax:360-574-9685
Practice Address - Street 1:20 SE 103RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2866
Practice Address - Country:US
Practice Address - Phone:360-574-9565
Practice Address - Fax:360-574-9685
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical