Provider Demographics
NPI:1639410525
Name:EVANS, JACQUELINE ROSE (DBH, LCSW, LCADC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ROSE
Last Name:EVANS
Suffix:
Gender:F
Credentials:DBH, LCSW, LCADC
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:ROSE
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LCADC
Mailing Address - Street 1:9402 W LAKE MEAD BLVD OFC 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-8312
Mailing Address - Country:US
Mailing Address - Phone:702-381-3414
Mailing Address - Fax:702-254-7830
Practice Address - Street 1:9402 W LAKE MEAD BLVD OFC 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8312
Practice Address - Country:US
Practice Address - Phone:702-381-3414
Practice Address - Fax:702-254-7830
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-03
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00302-C101YA0400X
7063-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)