MEDICARE: EVANS COUNSELING AND CONSULTING, LLC

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	1041C0700X	Clinical Social Worker	11029	SC

General Provider Information

NPI Number	:	1710481452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANS COUNSELING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	2000 PARK ST STE 102
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2011
Country	:	US
Telephone Number	:	804-567-0064
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 READ ST STE I-7
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-7861
Country	:	US
Telephone Number	:	803-567-0064
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MRS. TYANNA EVANS
Credential	:	LISW-CP
Telephone Number	:	803-995-0405

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	01/02/2026

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