Provider Demographics
NPI:1831657790
Name:EVANS, SHANOA LASHAE (CIT)
Entity Type:Individual
Prefix:
First Name:SHANOA
Middle Name:LASHAE
Last Name:EVANS
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4866
Mailing Address - Country:US
Mailing Address - Phone:337-345-6120
Mailing Address - Fax:
Practice Address - Street 1:401 W VERMILION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6729
Practice Address - Country:US
Practice Address - Phone:337-345-6124
Practice Address - Fax:337-524-1420
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4162101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)