Provider Demographics
NPI:1649530098
Name:EVANS, COURTNEY LASHUN (MSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LASHUN
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CREEKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-8308
Mailing Address - Country:US
Mailing Address - Phone:404-694-4540
Mailing Address - Fax:
Practice Address - Street 1:304 CREEKSIDE CIR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-8308
Practice Address - Country:US
Practice Address - Phone:404-694-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker