Provider Demographics
NPI:1417605494
Name:EVANS, KEATRAH (LCMHC)
Entity Type:Individual
Prefix:
First Name:KEATRAH
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:KEATRAH
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5200 PARAMOUNT PKWY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5469
Mailing Address - Country:US
Mailing Address - Phone:804-479-8488
Mailing Address - Fax:
Practice Address - Street 1:5200 PARAMOUNT PKWY
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5469
Practice Address - Country:US
Practice Address - Phone:804-479-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty