Individual
VICTORIA EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6548 TOWN CENTER DR STE D, CLARKSTON, MI 48346-4823
(586) 244-8052
Mailing address
1697 CARDIFF ROW, SUPERIOR TOWNSHIP, MI 48198-3587
(586) 244-8052
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401019743
MI
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
6401017276
MI
101YM0800X
Mental Health Counselor
6401019743
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101YA0400X
—
MI
05
—
1326439399
—
MI
Enumeration date
02/12/2015
Last updated
01/16/2025
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