Provider Demographics
NPI:1194871095
Name:EVANS, CHRISTINE LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 41ST AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3930
Mailing Address - Country:US
Mailing Address - Phone:831-818-4569
Mailing Address - Fax:
Practice Address - Street 1:2680 BAYSHORE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-1022
Practice Address - Country:US
Practice Address - Phone:650-314-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18533103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist