Provider Demographics
NPI:1376259911
Name:EVANS, ALISSA (ALC)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 AB COTTON DR
Mailing Address - Street 2:
Mailing Address - City:HEADLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36345-9201
Mailing Address - Country:US
Mailing Address - Phone:334-655-9446
Mailing Address - Fax:
Practice Address - Street 1:2489 COUNTY ROAD 79 S
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-5223
Practice Address - Country:US
Practice Address - Phone:334-845-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04379101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor