Provider Demographics
NPI:1639577760
Name:EVANS, JUNE (LBSW)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15675 S PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6011
Mailing Address - Country:US
Mailing Address - Phone:734-374-8928
Mailing Address - Fax:
Practice Address - Street 1:15675 S PLAZA DR
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6011
Practice Address - Country:US
Practice Address - Phone:734-374-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020215411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical