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General NPI Number Information
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NPI Number | 1053988022
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Entity Type | Individual
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Provider Name | NICHOLAS J EVANS LMHC, SUDP
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Gender | Male
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 1855 MAIN ST STE 207
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City | FERNDALE
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State | WA
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Zip | 98248-9060
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Country | US
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Telephone | 360-230-8528
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Fax |
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Provider Business Mailing Address
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Address Line | 1855 MAIN ST STE B207
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City | FERNDALE
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State | WA
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Zip | 98248-9062
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Country | US
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Telephone | 360-230-8528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH70047714
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP61269485
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License Number State | WA
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