Active NPI
Jerry Don Evans Jr.
- Addiction (Substance Use Disorder) Counselor
- Richmond, CA
National Provider Identifier
1790558013
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- C035739015
- Practice address
- 1313 Cutting Blvd
Richmond, CA 94804-2554 - Phone
- (510) 232-0874
- NPI assigned
- Oct 31, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | C035739015 | CA | Primary |
Addresses
Primary practice location
1313 Cutting Blvd
Richmond, CA 94804-2554
Mailing address
2321 International Blvd
Oakland, CA 94601-1018
Phone (530) 282-9054
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C035739015 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698710400000",
"number": "1790558013",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2321 INTERNATIONAL BLVD",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946011018",
"telephone_number": "530-282-9054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1313 CUTTING BLVD",
"city": "RICHMOND",
"state": "CA",
"postal_code": "948042554",
"telephone_number": "510-232-0874"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "JERRY",
"middle_name": "DON",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-10-31",
"last_updated": "2023-10-31",
"certification_date": "2023-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "C035739015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.