Healthcare Provider Details

I. General information

NPI: 1538886965
Provider Name (Legal Business Name): LAUREN ARIELLE EVANS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CARNEGIE PL STE 102
FAYETTEVILLE GA
30214-3900
US

IV. Provider business mailing address

7020 RIDGEMOOR TRCE
STONECREST GA
30038-7170
US

V. Phone/Fax

Practice location:
  • Phone: 770-694-6349
  • Fax:
Mailing address:
  • Phone: 404-422-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002002
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: