Provider Demographics
NPI:1841961174
Name:EVANS, ANTERRIO
Entity type:Individual
Prefix:MR
First Name:ANTERRIO
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 NOBLE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3660
Mailing Address - Country:US
Mailing Address - Phone:704-785-0604
Mailing Address - Fax:
Practice Address - Street 1:5210 NOBLE DR APT 102
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3660
Practice Address - Country:US
Practice Address - Phone:704-785-0604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician