Provider Demographics
NPI:1003165069
Name:EVANS, DIAN (JD, PHD)
Entity type:Individual
Prefix:DR
First Name:DIAN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-4876
Mailing Address - Country:US
Mailing Address - Phone:212-724-5555
Mailing Address - Fax:
Practice Address - Street 1:7000 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-4876
Practice Address - Country:US
Practice Address - Phone:212-724-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019178103TC0700X, 103G00000X, 103TF0200X
SC1198103TC0700X, 103G00000X
LA1179103TC0700X, 103G00000X
NJ35SI00556200103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic