MEDICARE: LAURA A EVANS LPC

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	101YP2500X	Professional Counselor	0701007851	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0701007851	OTHER	VA	LPC

General Provider Information

NPI Number	:	1821570839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA A EVANS LPC

Provider Business Mailing Address
First Line	:	24 CLAY ST
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-2810
Country	:	US
Telephone Number	:	276-632-2108
Fax Number	:	276-632-0127

Provider Business Practice Location Address
First Line	:	6 WALL ST STE 200
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-2700
Country	:	US
Telephone Number	:	276-258-6139
Fax Number	:

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	04/16/2026

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