Provider Demographics
NPI:1407013816
Name:EVANS, MONIQUE DENISE (BS CAC-AD)
Entity Type:Individual
Prefix:MISS
First Name:MONIQUE
Middle Name:DENISE
Last Name:EVANS
Suffix:
Gender:F
Credentials:BS CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 LANVALE ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5236
Mailing Address - Country:US
Mailing Address - Phone:301-992-4111
Mailing Address - Fax:
Practice Address - Street 1:111 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6680
Practice Address - Country:US
Practice Address - Phone:301-264-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0668101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)