Provider Demographics
NPI:1639807019
Name:EVANS, THOMAS VICTOR (MAE, EDS, NCSP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:VICTOR
Last Name:EVANS
Suffix:
Gender:M
Credentials:MAE, EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:GLENBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1710
Mailing Address - Country:US
Mailing Address - Phone:207-266-9193
Mailing Address - Fax:
Practice Address - Street 1:LEE COUNTY PUBLIC SCHOOLS
Practice Address - Street 2:155 VO TECH DRIVE
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263
Practice Address - Country:US
Practice Address - Phone:276-346-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-0606642103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool