Provider Demographics
NPI:1942557889
Name:EVENSEN, JAMES (BA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:EVENSEN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 REIDSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6636
Mailing Address - Country:US
Mailing Address - Phone:321-947-1938
Mailing Address - Fax:
Practice Address - Street 1:40 REIDSVILLE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6636
Practice Address - Country:US
Practice Address - Phone:321-947-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst