Provider Demographics
NPI:1982593984
Name:EVANS, SHAUNNA TYNICE (LGSW)
Entity type:Individual
Prefix:MS
First Name:SHAUNNA
Middle Name:TYNICE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21687 DOVEKIE TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3063
Mailing Address - Country:US
Mailing Address - Phone:703-434-0229
Mailing Address - Fax:
Practice Address - Street 1:14900 BOGLE DR STE 200
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1757
Practice Address - Country:US
Practice Address - Phone:571-484-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG200001704104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker