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General NPI Number Information
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NPI Number | 1346046950
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Entity Type | Individual
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Provider Name | DAVID EVANS
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Gender | Male
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 5342 MEADOW LANE CT
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City | SHEFFIELD VILLAGE
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State | OH
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Zip | 44035-1469
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Country | US
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Telephone | 440-934-2533
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Fax |
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Provider Business Mailing Address
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Address Line | 5400 GARGASZ DR
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City | LORAIN
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State | OH
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Zip | 44053-3360
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Country | US
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Telephone | 419-503-3474
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.188842
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License Number State | OH
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