Healthcare Provider Details

I. General information

NPI: 1114216835
Provider Name (Legal Business Name): SANDRA L. EVANS MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 BULTMAN DR SUITE D-1
SUMTER SC
29150-2553
US

IV. Provider business mailing address

2117-B WEST PALMETTO STREET SUITE 130
FLORENCE SC
29501-3925
US

V. Phone/Fax

Practice location:
  • Phone: 843-758-4587
  • Fax:
Mailing address:
  • Phone: 843-758-4587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: