Doctor Name: | ANGELA M EVERETTE |
NPI Number: | 1467640086 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CADC |
License Number: | |
Business Practice Address: | 323 W Mulberry St Watseka, IL - 609701568 |
Business Phone Number: | 8154325241 |
Business Fax Number: | 8154324537 |
Mailing Address: | Po Box 322, WATSEKA |
State: | IL |
Postal Code: | 609700322 |
Phone Number: | 8154325241 |
Fax Number: | 8154324537 |
NPI Enumeration Date: | 10/09/2007 |
NPI Last Update Date: | 06/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |