Healthcare Provider Details

I. General information

NPI: 1861279069
Provider Name (Legal Business Name): EVAN KNIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 TERRACE AVE
HUNTINGTON WV
25705-1754
US

IV. Provider business mailing address

218 11TH AVE
HUNTINGTON WV
25701-3115
US

V. Phone/Fax

Practice location:
  • Phone: 304-521-1100
  • Fax:
Mailing address:
  • Phone: 304-840-3327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number823
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: