Provider Demographics
NPI:1831220979
Name:EVANS, WAYNE EDWARD (PHD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:EDWARD
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:8705 COLESVILLE RD STE B
Mailing Address - Street 2:#241
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-509-7211
Mailing Address - Fax:888-804-0516
Practice Address - Street 1:1 RESEARCH CT.
Practice Address - Street 2:#450
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-509-7211
Practice Address - Fax:888-804-0516
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD04059103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04059Medicaid