Provider Demographics
NPI:1821313248
Name:EVANS, BELTON KINARD (LPC)
Entity Type:Individual
Prefix:MR
First Name:BELTON
Middle Name:KINARD
Last Name:EVANS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 VIREO DR
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3135
Mailing Address - Country:US
Mailing Address - Phone:803-378-2513
Mailing Address - Fax:
Practice Address - Street 1:2222 VIREO DR
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3135
Practice Address - Country:US
Practice Address - Phone:803-378-2513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC 005548OtherGEORGIA LICENSING BOARD