Provider Demographics
NPI:1497356257
Name:EVANS, HOLLIS ALLEN (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:HOLLIS
Middle Name:ALLEN
Last Name:EVANS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:EASTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4316
Mailing Address - Country:US
Mailing Address - Phone:267-907-2348
Mailing Address - Fax:
Practice Address - Street 1:13 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:EASTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-4316
Practice Address - Country:US
Practice Address - Phone:267-907-2348
Practice Address - Fax:609-835-5230
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJXXX00XX1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool