Healthcare Provider Details

I. General information

NPI: 1871096248
Provider Name (Legal Business Name): EVANS & ASSOCIATES PSYCHOLOGICAL AND COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24100 SOUTHFIELD RD STE 320A
SOUTHFIELD MI
48075-2819
US

IV. Provider business mailing address

24100 SOUTHFIELD RD STE 320A
SOUTHFIELD MI
48075-2819
US

V. Phone/Fax

Practice location:
  • Phone: 248-722-9300
  • Fax:
Mailing address:
  • Phone: 248-722-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL EVANS
Title or Position: SOLE OWNER
Credential: LLP, LPC
Phone: 248-722-9300