Provider Demographics
NPI:1902938582
Name:EVANS, SUSAN ANNE (MS/ LPCC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ANNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS/ LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 ALLENTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-9413
Mailing Address - Country:US
Mailing Address - Phone:419-339-1605
Mailing Address - Fax:
Practice Address - Street 1:5530 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-9413
Practice Address - Country:US
Practice Address - Phone:419-339-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002969101YP2500X
OHS-0012213104100000X
KYKY-1216101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker