Provider Demographics
NPI:1750829776
Name:EVANS, SHARDE' RENEE'
Entity Type:Individual
Prefix:MS
First Name:SHARDE'
Middle Name:RENEE'
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8023 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1084
Mailing Address - Country:US
Mailing Address - Phone:318-278-4568
Mailing Address - Fax:
Practice Address - Street 1:8023 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1084
Practice Address - Country:US
Practice Address - Phone:318-278-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health