Healthcare Provider Details

I. General information

NPI: 1033023296
Provider Name (Legal Business Name): AJAYLA EVINS PH.D., CRC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 YORK ST APT 2502
NORFOLK VA
23510-1551
US

IV. Provider business mailing address

269 YORK ST APT 2502
NORFOLK VA
23510-1551
US

V. Phone/Fax

Practice location:
  • Phone: 912-501-9204
  • Fax:
Mailing address:
  • Phone: 912-501-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC010954
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0704017792
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number631721
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: