Healthcare Provider Details

I. General information

NPI: 1821882416
Provider Name (Legal Business Name): STEPHANIE JOY EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 CUMMINGS HWY STE 110
CHATTANOOGA TN
37419-2438
US

IV. Provider business mailing address

840 VINE ST
CHATTANOOGA TN
37403-2337
US

V. Phone/Fax

Practice location:
  • Phone: 423-933-2575
  • Fax:
Mailing address:
  • Phone: 423-667-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: