Provider Demographics
NPI:1962988212
Name:EVANS, MOLLY (LGSW)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 BENTON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1766
Mailing Address - Country:US
Mailing Address - Phone:202-413-6899
Mailing Address - Fax:
Practice Address - Street 1:4250 MASSACHUSETTS AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5620
Practice Address - Country:US
Practice Address - Phone:202-488-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500824971041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool