Provider Demographics
NPI:1235536095
Name:EVANS, MARIA (LLP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42000 6 MILE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4374
Mailing Address - Country:US
Mailing Address - Phone:248-283-3703
Mailing Address - Fax:
Practice Address - Street 1:42000 6 MILE RD STE 202
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4374
Practice Address - Country:US
Practice Address - Phone:248-283-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015927103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist