Provider Information for 1750057758
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ERICA EVANS LCSW
Sex: Female
NPI: 1750057758
Last Updated: 2021-08-19
Certification Date: 2021-08-19
Certification Date: 2021-08-19
Details
Name | Value | ||||||||||||||
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NPI | 1750057758 | ||||||||||||||
Enumeration Date | 2021-08-19 | ||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||
Sole Proprietor | YES | ||||||||||||||
Status | Active | ||||||||||||||
Mailing Address | 427 BUCKBOARD LN LOCUST GROVE, GA 30248-3689 United States Phone: | Fax: | ||||||||||||||
Primary Practice Address | 427 BUCKBOARD LN LOCUST GROVE, GA 30248-3689 United States Phone: 808-772-2099 | Fax: | ||||||||||||||
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