Provider Demographics
NPI:1659963940
Name:EVANS, DANA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 COLLEGE AVE SE # 303
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5921
Mailing Address - Country:US
Mailing Address - Phone:616-229-4815
Mailing Address - Fax:
Practice Address - Street 1:103 COLLEGE AVE SE # 303
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5921
Practice Address - Country:US
Practice Address - Phone:616-229-4815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011070111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical