Healthcare Provider Details

I. General information

NPI: 1003042011
Provider Name (Legal Business Name): DAVE SCOTT EVANS MS, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 EAST COLLEGE
CARBONDALE IL
62901
US

IV. Provider business mailing address

604 EAST COLLEGE
CARBONDALE IL
62901
US

V. Phone/Fax

Practice location:
  • Phone: 618-457-6703
  • Fax: 618-529-4563
Mailing address:
  • Phone: 618-457-6703
  • Fax: 618-529-4563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22067
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: