Healthcare Provider Details

I. General information

NPI: 1619895331
Provider Name (Legal Business Name): DAISHA NICHOLE EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 BREEZEWOOD AVE
FAYETTEVILLE NC
28303-5503
US

IV. Provider business mailing address

276 LEGACY LN
LILLINGTON NC
27546-7281
US

V. Phone/Fax

Practice location:
  • Phone: 180-498-5105
  • Fax: 180-498-5105
Mailing address:
  • Phone: 919-830-9274
  • Fax: 919-830-9274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: