Healthcare Provider Details

I. General information

NPI: 1295256832
Provider Name (Legal Business Name): SHEILA EVANS LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHEILA GILLIS

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 07/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MONT BLANC BLVD
DOVER DE
19904-7615
US

IV. Provider business mailing address

PO BOX 172
DOVER DE
19903-0172
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-3020
  • Fax:
Mailing address:
  • Phone: 302-678-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0000814
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: