Healthcare Provider Details

I. General information

NPI: 1568947240
Provider Name (Legal Business Name): LADAWN NICHELLE EVANS PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28423 ORCHARD LAKE RD STE 205
FARMINGTON HILLS MI
48334-5707
US

IV. Provider business mailing address

7203 PEBBLE PARK DR
WEST BLOOMFIELD MI
48322-3507
US

V. Phone/Fax

Practice location:
  • Phone: 616-644-1560
  • Fax:
Mailing address:
  • Phone: 616-644-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017336
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: