Provider Demographics
NPI:1255868444
Name:EVANS, CARLA (LGPC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 AUTH RD APT 530
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4389
Mailing Address - Country:US
Mailing Address - Phone:301-747-3345
Mailing Address - Fax:240-838-7001
Practice Address - Street 1:5402 AUTH RD APT 530
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4389
Practice Address - Country:US
Practice Address - Phone:301-747-3345
Practice Address - Fax:240-838-7001
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$Medicaid