Provider Demographics
NPI:1073949566
Name:COLON, EVITA ALBA (LMHC)
Entity type:Individual
Prefix:MS
First Name:EVITA
Middle Name:ALBA
Last Name:COLON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E 119TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-3626
Mailing Address - Country:US
Mailing Address - Phone:917-318-2640
Mailing Address - Fax:
Practice Address - Street 1:10420 QUEENS BLVD
Practice Address - Street 2:SUITE 22C
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3629
Practice Address - Country:US
Practice Address - Phone:516-661-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP87334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health