Provider Demographics
NPI:1356841845
Name:EVANS, MEGAN CATHERINE (BSW, QMHP-T, RBT)
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:CATHERINE
Last Name:EVANS
Suffix:
Gender:F
Credentials:BSW, QMHP-T, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12731 MARBLESTONE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-8334
Mailing Address - Country:US
Mailing Address - Phone:571-589-0201
Mailing Address - Fax:
Practice Address - Street 1:5893 ANTHONY DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-3619
Practice Address - Country:US
Practice Address - Phone:202-805-2167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-23-290626106S00000X
VA0734006918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician