Provider Demographics
NPI:1871133843
Name:EVANS, ALEXIS CYMONE (LMFTA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CYMONE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 DAVID DR APT F5
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4802
Mailing Address - Country:US
Mailing Address - Phone:252-204-1074
Mailing Address - Fax:
Practice Address - Street 1:111 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-1803
Practice Address - Country:US
Practice Address - Phone:252-758-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12170A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist