Provider Demographics
NPI:1285462135
Name:EVANS, VICTORIA (LCDC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1625
Mailing Address - Country:US
Mailing Address - Phone:254-297-8999
Mailing Address - Fax:
Practice Address - Street 1:2220 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1625
Practice Address - Country:US
Practice Address - Phone:254-297-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16947101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)