Provider Demographics
NPI:1902071921
Name:EVANS, MEGAN (CAC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RODERICK ST STE B
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-2247
Mailing Address - Country:US
Mailing Address - Phone:985-380-2460
Mailing Address - Fax:985-380-2476
Practice Address - Street 1:500 RODERICK ST STE B
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-2247
Practice Address - Country:US
Practice Address - Phone:985-380-2460
Practice Address - Fax:985-380-2476
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1231101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)