Provider Demographics
NPI:1992041578
Name:EVANS, CARLA ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 LOW BUSH CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-7751
Mailing Address - Country:US
Mailing Address - Phone:910-612-3815
Mailing Address - Fax:
Practice Address - Street 1:6709 LOW BUSH CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-7751
Practice Address - Country:US
Practice Address - Phone:910-612-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-30
Last Update Date:2012-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4047235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist