Provider Demographics
NPI:1497580047
Name:EVERSLEY, YONETTE NICOLE MATILDE
Entity type:Individual
Prefix:
First Name:YONETTE
Middle Name:NICOLE MATILDE
Last Name:EVERSLEY
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 1:208 STEEPLE CT
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4595
Mailing Address - Country:US
Mailing Address - Phone:347-494-2760
Mailing Address - Fax:
Practice Address - Street 1:208 STEEPLE CT
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4595
Practice Address - Country:US
Practice Address - Phone:347-494-2760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18-P123904-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health