Provider Demographics
NPI:1912610759
Name:EVANS, HENRY (MA)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 DONOHUE RD APT 15
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-6402
Mailing Address - Country:US
Mailing Address - Phone:978-270-4582
Mailing Address - Fax:
Practice Address - Street 1:395 DONOHUE RD APT 15
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-6402
Practice Address - Country:US
Practice Address - Phone:978-270-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health