Healthcare Provider Details

I. General information

NPI: 1588091441
Provider Name (Legal Business Name): DARCIE EVANS LICSW COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 GOLDFINCH DR
NANTUCKET MA
02554-6008
US

IV. Provider business mailing address

67 GOLDFINCH DR
NANTUCKET MA
02554-6008
US

V. Phone/Fax

Practice location:
  • Phone: 508-825-2552
  • Fax: 508-825-0831
Mailing address:
  • Phone: 508-825-2552
  • Fax: 508-825-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number110335
License Number StateMA

VIII. Authorized Official

Name: DARCIE L EVANS
Title or Position: MANAGING MEMBER
Credential: LICSW
Phone: 508-825-2552