Provider Demographics
NPI:1013176882
Name:EVANS, VICTORIA P (PHD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:P
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3579
Mailing Address - Country:US
Mailing Address - Phone:803-328-2210
Mailing Address - Fax:
Practice Address - Street 1:229 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3579
Practice Address - Country:US
Practice Address - Phone:803-328-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1078103G00000X, 103T00000X
NC3561103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist