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General NPI Number Information
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NPI Number | 1639237860
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Entity Type | Individual
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Provider Name | GENEVRA B EVANS LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 828 LANE ALLEN RD STE 219
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City | LEXINGTON
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State | KY
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Zip | 40504-3659
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Country | US
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Telephone | 260-483-9081
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Fax |
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Provider Business Mailing Address
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Address Line | 152 COUILLARD RD
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City | PALERMO
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State | ME
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Zip | 04354-7666
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Country | US
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Telephone | 207-993-2741
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC6737
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 258271
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License Number State | KY
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