Provider Demographics
NPI:1417234311
Name:EVANS, JAMES DENNIS III (LMHC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DENNIS
Last Name:EVANS
Suffix:III
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 DEEPBROOK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5752
Mailing Address - Country:US
Mailing Address - Phone:727-455-4977
Mailing Address - Fax:813-681-2208
Practice Address - Street 1:221 PAULS DR STE A
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3897
Practice Address - Country:US
Practice Address - Phone:813-685-2221
Practice Address - Fax:813-681-2208
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8372101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)