Provider Demographics
NPI:1164533402
Name:EVANS, DARCIE LINN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DARCIE
Middle Name:LINN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MAIN ST
Mailing Address - Street 2:PO BOX 49
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2123
Mailing Address - Country:US
Mailing Address - Phone:508-825-2552
Mailing Address - Fax:508-825-0831
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2123
Practice Address - Country:US
Practice Address - Phone:508-825-2552
Practice Address - Fax:508-825-0831
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110335101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22306Medicare ID - Type Unspecified