Healthcare Provider Details

I. General information

NPI: 1891463675
Provider Name (Legal Business Name): EVANA HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2021
Last Update Date: 09/05/2021
Certification Date: 09/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 HARBOR CENTER DR STE 102G
WOODBRIDGE VA
22192-2847
US

IV. Provider business mailing address

12526 HOMESTEAD DR
NOKESVILLE VA
20181-1702
US

V. Phone/Fax

Practice location:
  • Phone: 571-292-6272
  • Fax:
Mailing address:
  • Phone: 571-292-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EVELYN NUWORDU
Title or Position: BUSINESS OWNER
Credential: DNP
Phone: 571-292-6272