MEDICARE: VIVETTE KATHERINE EVANS CDCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	162276	OH

General Provider Information

NPI Number	:	1780477497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVETTE KATHERINE EVANS CDCA

Provider Business Mailing Address
First Line	:	22709 LAKE SHORE BLVD APT 446C
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-1353
Country	:	US
Telephone Number	:	216-647-1445
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 SACKETT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1249
Country	:	US
Telephone Number	:	216-273-7974
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	05/26/2025

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