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General NPI Number Information
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NPI Number | 1871096248
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Entity Type | Organization
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Legal Business Name | EVANS & ASSOCIATES PSYCHOLOGICAL AND COUNSELING SERVICES
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 24100 SOUTHFIELD RD STE 320A
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2819
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Country | US
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Telephone | 248-722-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 24100 SOUTHFIELD RD STE 320A
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2819
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Country | US
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Telephone | 248-722-9300
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | RACHAEL EVANS
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Credential | LLP, LPC
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Telephone | 248-722-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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