Provider Demographics
NPI:1780166603
Name:KELLEY CORREA, EVOANNA KILEEN (LCSW)
Entity type:Individual
Prefix:MS
First Name:EVOANNA
Middle Name:KILEEN
Last Name:KELLEY CORREA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 9TH ST NW APT 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3758
Mailing Address - Country:US
Mailing Address - Phone:608-449-3847
Mailing Address - Fax:
Practice Address - Street 1:4619 9TH ST NW APT 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3758
Practice Address - Country:US
Practice Address - Phone:608-449-3837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9639-1231041C0700X
FLSW248151041C0700X
1041C0700X
NMSWB-2024-13061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical