Provider Demographics
NPI:1780477497
Name:EVANS, VIVETTE KATHERINE (CDCA)
Entity type:Individual
Prefix:
First Name:VIVETTE
Middle Name:KATHERINE
Last Name:EVANS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22709 LAKE SHORE BLVD APT 446C
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1353
Mailing Address - Country:US
Mailing Address - Phone:216-647-1445
Mailing Address - Fax:
Practice Address - Street 1:4207 SACKETT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1249
Practice Address - Country:US
Practice Address - Phone:216-273-7974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162276101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)