Provider Demographics
NPI:1295350080
Name:EVANS, TAMELA (NCC, LPC, EDD)
Entity type:Individual
Prefix:DR
First Name:TAMELA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:NCC, LPC, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2791
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85902-2791
Mailing Address - Country:US
Mailing Address - Phone:757-470-4348
Mailing Address - Fax:
Practice Address - Street 1:4210 COLUMBIA RD STE 11B
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0443
Practice Address - Country:US
Practice Address - Phone:757-470-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17952101YP2500X
GALPC-008818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional