Provider Demographics
NPI:1942557889
Name:EVENSEN, JAMES (MA BCBA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:EVENSEN
Suffix:
Gender:M
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 COUNTY ROAD 2006 W
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-5514
Mailing Address - Country:US
Mailing Address - Phone:321-947-1938
Mailing Address - Fax:
Practice Address - Street 1:3408 S ATLANTIC AVE
Practice Address - Street 2:PMB 1052
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118
Practice Address - Country:US
Practice Address - Phone:321-947-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker