Provider Demographics
NPI:1679696132
Name:EVANS, RICHARD CRAIG (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CRAIG
Last Name:EVANS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6432
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91359-6432
Mailing Address - Country:US
Mailing Address - Phone:805-777-3500
Mailing Address - Fax:
Practice Address - Street 1:72 MOODY CT
Practice Address - Street 2:VTA. CO. ADULT BEHAVIORAL HEALTH DEPT.
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6067
Practice Address - Country:US
Practice Address - Phone:805-777-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 39271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical