Provider Demographics
NPI:1881126456
Name:EVANS, JARRETT LAMONT (LCMHC, LCAS-A, NCC)
Entity type:Individual
Prefix:MR
First Name:JARRETT
Middle Name:LAMONT
Last Name:EVANS
Suffix:
Gender:M
Credentials:LCMHC, LCAS-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11845 RIDGEWAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2989
Mailing Address - Country:US
Mailing Address - Phone:704-649-7347
Mailing Address - Fax:
Practice Address - Street 1:XXXXXX
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8797
Practice Address - Country:US
Practice Address - Phone:704-649-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12879101YP2500X
NC12879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional