Provider Demographics
NPI:1972848224
Name:EVANS, REBECCA A
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6153 FAIRMOUNT AVE
Mailing Address - Street 2:260
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3443
Mailing Address - Country:US
Mailing Address - Phone:619-481-3790
Mailing Address - Fax:
Practice Address - Street 1:3340 KEMPER ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4907
Practice Address - Country:US
Practice Address - Phone:619-523-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health