Provider Demographics
NPI:1740363530
Name:EVANS, ALISON Y (PHD)
Entity type:Individual
Prefix:DR
First Name:ALISON
Middle Name:Y
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-0553
Mailing Address - Country:US
Mailing Address - Phone:843-383-5169
Mailing Address - Fax:843-383-0770
Practice Address - Street 1:302 DUNLAP DR
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4943
Practice Address - Country:US
Practice Address - Phone:843-383-5169
Practice Address - Fax:843-383-0770
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional