Provider Demographics
NPI:1871248336
Name:DECROIX, EVA REAGAN (AMFT)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:REAGAN
Last Name:DECROIX
Suffix:
Gender:
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12552 SAINT MARK ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2448
Mailing Address - Country:US
Mailing Address - Phone:623-460-8035
Mailing Address - Fax:
Practice Address - Street 1:2081 PALOS VERDES DR N
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3799
Practice Address - Country:US
Practice Address - Phone:310-325-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist