Provider Demographics
NPI:1205074747
Name:EVANS, DAVID WESLEY (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WESLEY
Last Name:EVANS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:WES
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:133 PAL RD
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-2909
Mailing Address - Country:US
Mailing Address - Phone:478-374-7968
Mailing Address - Fax:
Practice Address - Street 1:133 PAL RD
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-2909
Practice Address - Country:US
Practice Address - Phone:478-374-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional