MEDICARE: SARA LOUISE EVANS LPC NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC1720	WV

General Provider Information

NPI Number	:	1225052715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA LOUISE EVANS LPC NCC

Provider Business Mailing Address
First Line	:	590 GOLDSBOROUGH RD
Second Line	:
City	:	SPRINGFIELD
State	:	WV
Zip	:	26763-5617
Country	:	US
Telephone Number	:	304-298-4443
Fax Number	:	304-298-4443

Provider Business Practice Location Address
First Line	:	9998 FRANKFORT HIGHWAY
Second Line	:
City	:	FORT ASHBY
State	:	WV
Zip	:	26719
Country	:	US
Telephone Number	:	304-298-4443
Fax Number	:	304-298-4443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	06/13/2016

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