Provider Demographics
NPI:1841668480
Name:EVANS, DEBORRAH (MSW)
Entity type:Individual
Prefix:MISS
First Name:DEBORRAH
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:DEBORRAH
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:852 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94130-2002
Mailing Address - Country:US
Mailing Address - Phone:415-217-8422
Mailing Address - Fax:
Practice Address - Street 1:852 AVENUE D
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94130-2002
Practice Address - Country:US
Practice Address - Phone:415-217-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARADT-I: R#1201590515101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)