Provider Demographics
NPI:1144049503
Name:EVINS, ANGEL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:EVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13311 GLEN ECHO CIR APT 206
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-5147
Mailing Address - Country:US
Mailing Address - Phone:703-371-3561
Mailing Address - Fax:
Practice Address - Street 1:12926 CEDAR GLEN LN
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2951
Practice Address - Country:US
Practice Address - Phone:703-371-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional