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General NPI Number Information
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NPI Number | 1316290489
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Entity Type | Organization
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Legal Business Name | JEANETTE EVANS, INC.
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 55 N CHURCH ST SUITE #2
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City | WAILUKU
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State | HI
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Zip | 96793-1682
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Country | US
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Telephone | 808-244-6881
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Fax |
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Provider Business Mailing Address
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Address Line | 3095 KEKAULIKE AVE
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City | KULA
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State | HI
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Zip | 96790-8483
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Country | US
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Telephone | 808-244-6881
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JEANETTE CHRISTINE EVANS
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Credential | DCSW, LCSW
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Telephone | 808-244-6881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 501
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License Number State | HI
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