Provider Demographics
NPI:1700343134
Name:EVANS-WHITNEY, KIM CAROLYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:CAROLYNN
Last Name:EVANS-WHITNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1426
Mailing Address - Country:US
Mailing Address - Phone:717-560-3782
Mailing Address - Fax:
Practice Address - Street 1:676 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1426
Practice Address - Country:US
Practice Address - Phone:717-560-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0191601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical