Provider Demographics
NPI:1144918939
Name:EVANS, JACOBIA K (LCMHCA)
Entity type:Individual
Prefix:
First Name:JACOBIA
Middle Name:K
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 EUGENE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2714
Mailing Address - Country:US
Mailing Address - Phone:336-365-8354
Mailing Address - Fax:336-365-2380
Practice Address - Street 1:418 EUGENE CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2714
Practice Address - Country:US
Practice Address - Phone:336-365-8354
Practice Address - Fax:336-365-2380
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional