Healthcare Provider Details

I. General information

NPI: 1598163479
Provider Name (Legal Business Name): CHRISTOPHER EVANS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 14TH ST
OAKLAND CA
94607-2205
US

IV. Provider business mailing address

2301 NORTHGATE AVE APT 307
OAKLAND CA
94612-1782
US

V. Phone/Fax

Practice location:
  • Phone: 510-530-8083
  • Fax:
Mailing address:
  • Phone: 510-504-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: