Provider Demographics
NPI:1366103202
Name:FERNANDEZ EVANS, A'SA MARIAH (LMSW)
Entity type:Individual
Prefix:
First Name:A'SA
Middle Name:MARIAH
Last Name:FERNANDEZ EVANS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:A'SA
Other - Middle Name:M
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1317 MONTERREY BLVD APT 134A
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-8181
Mailing Address - Country:US
Mailing Address - Phone:682-386-6575
Mailing Address - Fax:
Practice Address - Street 1:9407 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-3850
Practice Address - Country:US
Practice Address - Phone:214-353-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2024-11-06
Deactivation Date:2024-10-28
Deactivation Code:
Reactivation Date:2024-11-06
Provider Licenses
StateLicense IDTaxonomies
TX114148104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker