Provider Demographics
NPI:1568563161
Name:BISHOP, EVALYN G (PHD)
Entity Type:Individual
Prefix:DR
First Name:EVALYN
Middle Name:G
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 OAK FOREST CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-882-2631
Mailing Address - Fax:434-244-0716
Practice Address - Street 1:198 SPOTNAP RD STE A3
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8614
Practice Address - Country:US
Practice Address - Phone:434-882-2631
Practice Address - Fax:434-882-2631
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08100001917103TC0700X
103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA88096MOtherOPTIMA HEALYH
VA262463OtherVALUE OPTIONS CH'VILLE
VA105614OtherANTHEM BCBS
VA262463OtherVALUE OPTIONS
VA087576OtherOPTIMA HEALTH
VA88096MOtherOPTIMA HEALYH
VAR51823Medicare UPIN