Provider Demographics
NPI:1871698530
Name:EVANS, JOAN MARIE (LCSW, LPC)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 PIERPONT SOUTH EST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4155
Mailing Address - Country:US
Mailing Address - Phone:304-685-3590
Mailing Address - Fax:
Practice Address - Street 1:293 WILLEY ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5530
Practice Address - Country:US
Practice Address - Phone:304-685-3590
Practice Address - Fax:304-291-3214
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38101YM0800X
WVCP00451570104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker