Provider Demographics
NPI:1184439572
Name:EVANS, ERICA KAY
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:KAY
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 1:7990 BAYMEADOWS RD E UNIT 1001
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2977
Mailing Address - Country:US
Mailing Address - Phone:904-250-7363
Mailing Address - Fax:
Practice Address - Street 1:7990 BAYMEADOWS RD E UNIT 1001
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2977
Practice Address - Country:US
Practice Address - Phone:904-250-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)