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General NPI Number Information
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NPI Number | 1184902173
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Entity Type | Individual
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Provider Name | CATHLEEN SUZANNE EVANS M.S. ED, BCBA
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Gender | Female
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 1724 PATTINGTON CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5789
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Country | US
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Telephone | 757-761-6388
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Fax | 757-301-8472
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Provider Business Mailing Address
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Address Line | 1724 PATTINGTON CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5789
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Country | US
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Telephone | 757-761-6388
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Fax | 757-301-8472
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-11-860
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License Number State | VA
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