Provider Demographics
NPI:1700617644
Name:EVANS, KANEISHA S (LCMHCA)
Entity type:Individual
Prefix:
First Name:KANEISHA
Middle Name:S
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 1:249 E NC HIGHWAY 54 STE 320
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2490
Mailing Address - Country:US
Mailing Address - Phone:919-907-3334
Mailing Address - Fax:919-907-3335
Practice Address - Street 1:249 E NC HIGHWAY 54 STE 320
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2490
Practice Address - Country:US
Practice Address - Phone:919-907-3334
Practice Address - Fax:919-907-3335
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-30196101YA0400X
NCA20209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)