Provider Demographics
NPI:1851134282
Name:POWELL, EVAN NICOLE (MSW)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:NICOLE
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 E DEERE AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5716
Mailing Address - Country:US
Mailing Address - Phone:714-926-3718
Mailing Address - Fax:
Practice Address - Street 1:1932 E DEERE AVE STE 240
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5716
Practice Address - Country:US
Practice Address - Phone:714-926-3718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96077104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker