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General NPI Number Information
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NPI Number | 1982593984
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Entity Type | Individual
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Provider Name | SHAUNNA TYNICE EVANS LGSW
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Gender | Female
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 14900 BOGLE DR STE 200
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City | CHANTILLY
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State | VA
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Zip | 20151-1757
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Country | US
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Telephone | 571-484-7639
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Fax |
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Provider Business Mailing Address
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Address Line | 21687 DOVEKIE TER
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City | ASHBURN
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State | VA
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Zip | 20147-3063
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Country | US
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Telephone | 703-434-0229
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LG200001704
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License Number State | DC
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