Provider Demographics
NPI:1811579824
Name:EVANS, DENEEN LOGAN (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DENEEN
Middle Name:LOGAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 PETERS CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2738
Mailing Address - Country:US
Mailing Address - Phone:540-520-1052
Mailing Address - Fax:540-566-4472
Practice Address - Street 1:3005 PETERS CREEK RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-2738
Practice Address - Country:US
Practice Address - Phone:540-520-1052
Practice Address - Fax:540-566-4472
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040128801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical