Provider Demographics
NPI:1437937893
Name:EVELYN, ALISA (DACM)
Entity Type:Individual
Prefix:DR
First Name:ALISA
Middle Name:
Last Name:EVELYN
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E MOREHEAD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2863
Mailing Address - Country:US
Mailing Address - Phone:347-997-1696
Mailing Address - Fax:
Practice Address - Street 1:1200 E MOREHEAD ST STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2863
Practice Address - Country:US
Practice Address - Phone:347-997-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17186225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist