Healthcare Provider Details

I. General information

NPI: 1457427833
Provider Name (Legal Business Name): DEBORAH K. EVANS LSCW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14900 BOGLE DR STE 200
CHANTILLY VA
20151-1756
US

IV. Provider business mailing address

10540 POAGUES BATTERY DR
BRISTOW VA
20136-1337
US

V. Phone/Fax

Practice location:
  • Phone: 703-472-6056
  • Fax: 703-817-9860
Mailing address:
  • Phone: 703-472-6056
  • Fax: 703-817-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003512
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: