Provider Demographics
NPI:1881257608
Name:EVANS, ANGEL CHARISSA (LICENSE SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:CHARISSA
Last Name:EVANS
Suffix:
Gender:F
Credentials:LICENSE SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11505 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-5053
Mailing Address - Country:US
Mailing Address - Phone:216-834-3857
Mailing Address - Fax:
Practice Address - Street 1:345 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3817
Practice Address - Country:US
Practice Address - Phone:805-489-4261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS30473104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker