Provider Demographics
NPI:1942576020
Name:EVOY, MATTHEW H JR (CDP, CCC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:H
Last Name:EVOY
Suffix:JR
Gender:M
Credentials:CDP, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5014
Mailing Address - Country:US
Mailing Address - Phone:360-676-4485
Mailing Address - Fax:360-714-1294
Practice Address - Street 1:1130 N STATE ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5014
Practice Address - Country:US
Practice Address - Phone:360-676-4485
Practice Address - Fax:360-714-1294
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004951101YA0400X
WACL60160856101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)