Provider Demographics
NPI:1801265442
Name:EVANS, JAVAI DOMINIQUE (LICSW)
Entity type:Individual
Prefix:MS
First Name:JAVAI
Middle Name:DOMINIQUE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 UTAH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-3091
Mailing Address - Country:US
Mailing Address - Phone:202-363-1333
Mailing Address - Fax:
Practice Address - Street 1:5901 UTAH AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1616
Practice Address - Country:US
Practice Address - Phone:202-363-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18326104100000X
DCLC500806811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker