Provider Demographics
NPI:1366507634
Name:EVANS, ANGELA L (DPA, LCPC, CADC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:DPA, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27492 US HIGHWAY 54
Mailing Address - Street 2:
Mailing Address - City:GRIGGSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62340-2214
Mailing Address - Country:US
Mailing Address - Phone:217-827-0737
Mailing Address - Fax:
Practice Address - Street 1:27492 US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:GRIGGSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62340-2214
Practice Address - Country:US
Practice Address - Phone:217-827-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24210101YA0400X
IL180006305101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)