Provider Demographics
NPI:1053905240
Name:EVANS, DOUGLAS E (LPC)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:EVANS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20487 DOVES POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48174-8505
Mailing Address - Country:US
Mailing Address - Phone:734-789-9709
Mailing Address - Fax:
Practice Address - Street 1:20487 DOVES POINTE DR
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48174-8505
Practice Address - Country:US
Practice Address - Phone:734-789-9709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional