Healthcare Provider Details

I. General information

NPI: 1932517836
Provider Name (Legal Business Name): TIA THEANN EVANS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CLANTON RD # RC114
CHARLOTTE NC
28217-1372
US

IV. Provider business mailing address

801 CLANTON RD # RC114
CHARLOTTE NC
28217-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-840-6088
  • Fax: 800-506-0738
Mailing address:
  • Phone: 704-840-6088
  • Fax: 800-506-0738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC010304
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: