Provider Demographics
NPI:1891957775
Name:EVANS, CONNIE S (LMHC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PINEAPPLE ST E
Mailing Address - Street 2:PO BOX 1039
Mailing Address - City:BOWLING GREEN
Mailing Address - State:FL
Mailing Address - Zip Code:33834-1039
Mailing Address - Country:US
Mailing Address - Phone:863-375-4052
Mailing Address - Fax:
Practice Address - Street 1:109 PINEAPPLE ST E
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:FL
Practice Address - Zip Code:33834-1039
Practice Address - Country:US
Practice Address - Phone:863-375-4052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YS0200X
FLMH8020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool