Provider Demographics
NPI:1023479425
Name:EVANS, REBECCA JANE (CADC INTERN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:EVANS
Suffix:
Gender:F
Credentials:CADC INTERN
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:JANE
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1023 SANTA YNEZ AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9012
Mailing Address - Country:US
Mailing Address - Phone:702-321-9516
Mailing Address - Fax:
Practice Address - Street 1:220 E HORIZON DR
Practice Address - Street 2:SUITE G
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8035
Practice Address - Country:US
Practice Address - Phone:702-565-5004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01964-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)