Provider Demographics
NPI:1912027558
Name:EVANS, TONA LYNN (LADC-CCS)
Entity Type:Individual
Prefix:MS
First Name:TONA
Middle Name:LYNN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LADC-CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5372
Mailing Address - Country:US
Mailing Address - Phone:207-945-4240
Mailing Address - Fax:207-990-3660
Practice Address - Street 1:970 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2722
Practice Address - Country:US
Practice Address - Phone:207-945-4240
Practice Address - Fax:207-990-3660
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC 1492101YA0400X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool