Healthcare Provider Details

I. General information

NPI: 1699890384
Provider Name (Legal Business Name): JOANN EVETTS LCSW SW12129
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ARMY PENTAGON DILORENZO PENTAGON HEALTH CLINIC
WASHINGTON DC
20310-0001
US

IV. Provider business mailing address

5801 ARMY PENTAGON DILORENZO PENTAGON HEALTH CLINIC
WASHINGTON DC
20310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-8878
  • Fax:
Mailing address:
  • Phone: 703-692-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: