Provider Demographics
NPI:1215089388
Name:EVANS, JEANETTE CHRISTINE (DCSW)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:CHRISTINE
Last Name:EVANS
Suffix:
Gender:F
Credentials:DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 KEKAULIKE AVE
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8483
Mailing Address - Country:US
Mailing Address - Phone:808-244-6881
Mailing Address - Fax:
Practice Address - Street 1:55 N CHURCH ST STE 2
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1684
Practice Address - Country:US
Practice Address - Phone:808-244-6881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILSW5011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical