Individual ProviderStephanie Evon HollisCounselorBehavioral Health & Social Service ProvidersPractice Address3408 Andover St, Oakland, CA 94609-2817(510) 393-4113PECOS EnrollmentBased on the most recent information from CMS, provider Stephanie Evon Hollis does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1295594547Provider TypeIndividualFull NameHollis, Stephanie EvonCredentialSUDRCGenderFemaleSole ProprietorNoEnumeration Date3/18/2024Last Updated3/18/2024Contact InformationPractice LocationPractice Address3408 Andover St, Oakland, CA 94609-2817Phone(510) 393-4113Fax(510) 487-2016Mailing LocationMailing Address3408 Andover St, Oakland, CA 94609-2817Phone(510) 393-4113Fax(510) 487-2016Provider TaxonomiesCodeDescriptionLicenseCode101YA0400XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense17596California