Provider Demographics
NPI:1366824427
Name:EVANS, STEPHENE LORAN (LISW, OCPC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHENE
Middle Name:LORAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LISW, OCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5666 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:WALBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43465-9595
Mailing Address - Country:US
Mailing Address - Phone:734-644-3543
Mailing Address - Fax:
Practice Address - Street 1:1832 ADAMS ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-4428
Practice Address - Country:US
Practice Address - Phone:419-214-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOCPC.161315405300000X
OHI.19017921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No405300000XOther Service ProvidersPrevention Professional