Provider Demographics
NPI:1912385584
Name:EVANGELISTA, KARINA (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S DIXIE HWY APT 501
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-7318
Mailing Address - Country:US
Mailing Address - Phone:954-589-3324
Mailing Address - Fax:
Practice Address - Street 1:17501 BISCAYNE BLVD STE 450
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4806
Practice Address - Country:US
Practice Address - Phone:954-589-3324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH12909101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health