Provider Demographics
NPI:1154698173
Name:BARDEN, EVAN THOMAS (LADC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:THOMAS
Last Name:BARDEN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DUNN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6821
Mailing Address - Country:US
Mailing Address - Phone:207-784-2901
Mailing Address - Fax:207-783-5134
Practice Address - Street 1:24 DUNN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6821
Practice Address - Country:US
Practice Address - Phone:207-784-2901
Practice Address - Fax:207-783-5134
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4527101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)