Provider Demographics
NPI:1457944506
Name:EVANS, CARLA (MS, APC, NCC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, APC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 DAHLONEGA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8219
Mailing Address - Country:US
Mailing Address - Phone:678-771-8468
Mailing Address - Fax:
Practice Address - Street 1:380 DAHLONEGA ST STE 100
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8219
Practice Address - Country:US
Practice Address - Phone:678-771-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007583101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health