Doctor Name: | LISA MARIE EVANICH |
NPI Number: | 1003010711 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LPC, CACIII |
License Number: | 6457 |
Business Practice Address: | 360 28 Rd Grand Junction, CO - 815014759 |
Business Phone Number: | 9702603321 |
Business Fax Number: | |
Mailing Address: | 360 28 Rd, GRAND JUNCTION |
State: | CO |
Postal Code: | 815014759 |
Phone Number: | 9702603321 |
Fax Number: | |
NPI Enumeration Date: | 06/14/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 6457 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |