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General NPI Number Information
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NPI Number | 1962035733
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Entity Type | Individual
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Provider Name | AISHA KATRELL EVANS LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/19/2020
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 300 TUSKEGEE BLVD
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City | DOVER
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State | DE
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Zip | 19902-5003
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Country | US
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Telephone | 302-677-2674
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Fax |
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Provider Business Mailing Address
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Address Line | 86 MDG, UNIT 3215 RAMSTEIN AB
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City | APO
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State | AE
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Zip | 09094
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Country | US
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Telephone |
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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 | C012598
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License Number State | NC
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