Provider Demographics
NPI:1831764976
Name:EVANS, JANISIA MCGOWAN (ALC)
Entity type:Individual
Prefix:
First Name:JANISIA
Middle Name:MCGOWAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 34TH PL N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35234-2215
Mailing Address - Country:US
Mailing Address - Phone:205-305-7610
Mailing Address - Fax:
Practice Address - Street 1:2008 21ST STREET ENSLEY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-2963
Practice Address - Country:US
Practice Address - Phone:205-224-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3715A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional