MEDICARE: MRS. TYANNA ASHLEY EVANS LISW-CP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	11029	SC

General Provider Information

NPI Number	:	1265709273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TYANNA ASHLEY EVANS LISW-CP

Provider Business Mailing Address
First Line	:	2000 PARK ST STE 102
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2011
Country	:	US
Telephone Number	:	803-567-0064
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 READ ST STE I-7
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-7861
Country	:	US
Telephone Number	:	803-567-0064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	01/02/2026

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