Healthcare Provider Details

I. General information

NPI: 1225052715
Provider Name (Legal Business Name): SARA LOUISE EVANS LPC NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9998 FRANKFORT HIGHWAY
FORT ASHBY WV
26719
US

IV. Provider business mailing address

590 GOLDSBOROUGH RD
SPRINGFIELD WV
26763-5617
US

V. Phone/Fax

Practice location:
  • Phone: 304-298-4443
  • Fax: 304-298-4443
Mailing address:
  • Phone: 304-298-4443
  • Fax: 304-298-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC1720
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: