Provider Demographics
NPI:1740220748
Name:EVANS, CHERI JEANNETTE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:JEANNETTE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-1331
Mailing Address - Fax:
Practice Address - Street 1:1208 EASTCHESTER DR STE 200
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-3165
Practice Address - Country:US
Practice Address - Phone:336-802-2205
Practice Address - Fax:336-802-2206
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0017111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106202Medicaid
NC1197EOtherBLUECROSS/BLUESHEILD
NC60-02077Medicaid
NC7931153OtherAETNA
NC1197EOtherBLUECROSS/BLUESHEILD
NC6106202Medicaid