Healthcare Provider Details

I. General information

NPI: 1659667004
Provider Name (Legal Business Name): ANGELA E EAVES-LEWIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA E EAVES LCSW

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 CLARA AVE
UKIAH CA
95482-4006
US

IV. Provider business mailing address

314 CLARA AVE
UKIAH CA
95482-4006
US

V. Phone/Fax

Practice location:
  • Phone: 707-490-6061
  • Fax:
Mailing address:
  • Phone: 707-490-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW104762
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCSW104762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: