Provider Demographics
NPI:1982374328
Name:POWLESS, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:POWLESS
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 1:5800 S EASTERN AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-4019
Mailing Address - Country:US
Mailing Address - Phone:626-782-5570
Mailing Address - Fax:323-680-4952
Practice Address - Street 1:5800 S EASTERN AVE STE 260
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-4019
Practice Address - Country:US
Practice Address - Phone:626-782-5570
Practice Address - Fax:323-680-4952
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAASW105284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator