Provider Demographics
NPI:1932514601
Name:EVANS, DONNETTA LAFAYE (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:DONNETTA
Middle Name:LAFAYE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 SANDY RIVER LN
Mailing Address - Street 2:APT 103
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4875
Mailing Address - Country:US
Mailing Address - Phone:980-242-7090
Mailing Address - Fax:
Practice Address - Street 1:2404 SANDY RIVER LN
Practice Address - Street 2:APT 103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4875
Practice Address - Country:US
Practice Address - Phone:704-430-5547
Practice Address - Fax:704-327-5547
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0128911041C0700X
NCP121121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical