Provider Demographics
NPI:1942997804
Name:COLON-VAZQUEZ, EVELYN (MA, LPC)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:COLON-VAZQUEZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WHITE PINE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-8175
Mailing Address - Country:US
Mailing Address - Phone:484-797-6150
Mailing Address - Fax:
Practice Address - Street 1:313 W LIBERTY ST STE 224
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2766
Practice Address - Country:US
Practice Address - Phone:717-173-9439
Practice Address - Fax:717-173-9401
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017129101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health