Provider Demographics
NPI:1952769374
Name:EVANS, TAYLOR (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 PRINCE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6004
Mailing Address - Country:US
Mailing Address - Phone:440-655-1831
Mailing Address - Fax:
Practice Address - Street 1:2340 PRINCE AVE
Practice Address - Street 2:STE B
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6004
Practice Address - Country:US
Practice Address - Phone:706-813-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-30
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006841104100000X
GACSW0058031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker