Provider Demographics
NPI:1043871528
Name:EVANS, SAMANTHA DEVIN (BA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DEVIN
Last Name:EVANS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:DEVIN
Other - Last Name:RANDALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 S ASSEMBLY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-2116
Mailing Address - Country:US
Mailing Address - Phone:509-892-9241
Mailing Address - Fax:509-892-9251
Practice Address - Street 1:1700 S ASSEMBLY RD STE 300
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-2116
Practice Address - Country:US
Practice Address - Phone:509-892-9241
Practice Address - Fax:509-892-9251
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical