Provider Demographics
NPI:1629026232
Name:EVANS, ALAN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 WILSON BLVD
Mailing Address - Street 2:STE A1
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2283
Mailing Address - Country:US
Mailing Address - Phone:540-886-5060
Mailing Address - Fax:540-886-7380
Practice Address - Street 1:1228 N AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3202
Practice Address - Country:US
Practice Address - Phone:540-886-5060
Practice Address - Fax:540-886-7380
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001661103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA044580OtherANTHEM
VA007702019Medicaid
VA044580OtherANTHEM
VAR61285Medicare UPIN