Provider Demographics
NPI:1649322173
Name:EVANS, JAMES WILLIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIAM
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2376 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-3030
Mailing Address - Country:US
Mailing Address - Phone:724-962-1761
Mailing Address - Fax:724-962-1761
Practice Address - Street 1:2376 LAKE RD
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-3030
Practice Address - Country:US
Practice Address - Phone:724-698-5924
Practice Address - Fax:724-962-1761
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003095L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist