Provider Demographics
NPI:1225052715
Name:EVANS, SARA LOUISE (LPC NCC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 GOLDSBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26763-5617
Mailing Address - Country:US
Mailing Address - Phone:304-298-4443
Mailing Address - Fax:304-298-4443
Practice Address - Street 1:9998 FRANKFORT HIGHWAY
Practice Address - Street 2:
Practice Address - City:FORT ASHBY
Practice Address - State:WV
Practice Address - Zip Code:26719
Practice Address - Country:US
Practice Address - Phone:304-298-4443
Practice Address - Fax:304-298-4443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVLPC1720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health