Provider Demographics
NPI:1912777541
Name:EVANS, ANAYA RUTH
Entity Type:Individual
Prefix:
First Name:ANAYA
Middle Name:RUTH
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 PATAPSCO LAND WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21225-2380
Mailing Address - Country:US
Mailing Address - Phone:413-222-7403
Mailing Address - Fax:
Practice Address - Street 1:122 PATAPSCO LAND WAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-2380
Practice Address - Country:US
Practice Address - Phone:413-222-7403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician