MEDICARE: DAVID EVANS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.188842	OH

General Provider Information

NPI Number	:	1346046950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID EVANS

Provider Business Mailing Address
First Line	:	5400 GARGASZ DR
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44053-3360
Country	:	US
Telephone Number	:	419-503-3474
Fax Number	:

Provider Business Practice Location Address
First Line	:	5342 MEADOW LANE CT
Second Line	:
City	:	SHEFFIELD VILLAGE
State	:	OH
Zip	:	44035-1469
Country	:	US
Telephone Number	:	440-934-2533
Fax Number	:

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

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	02/24/2025

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Directions to “ DAVID EVANS ” Practice Location

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