Provider Demographics
NPI:1629504865
Name:EVANS, REBECCA (MAC, CDPT, CADCIII,)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MAC, CDPT, CADCIII,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2444
Mailing Address - Country:US
Mailing Address - Phone:503-954-1890
Mailing Address - Fax:
Practice Address - Street 1:1010 5TH ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2444
Practice Address - Country:US
Practice Address - Phone:503-954-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-09
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60691835101YA0400X
OR16-01-03101YA0400X
OR511732101YA0400X
OR25-CRM-4605175T00000X
OR17-04-24101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR17-04-24OtherOREGON ADDICTION COUNSELOR CERTIFICATION BOARD
OR511732OtherNAADAC
OR17-04-24OtherOREGON ADDICTION COUNSELOR CERTIFICATION BOARD