Provider Demographics
NPI:1265709273
Name:EVANS, TYANNA ASHLEY (LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:TYANNA
Middle Name:ASHLEY
Last Name:EVANS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:TYANNA
Other - Middle Name:A
Other - Last Name:DOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:137 POTTERS VIEW RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7232
Mailing Address - Country:US
Mailing Address - Phone:803-995-0405
Mailing Address - Fax:
Practice Address - Street 1:2601 READ ST STE I-7
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-7861
Practice Address - Country:US
Practice Address - Phone:803-567-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC110291041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical