Provider Demographics
NPI:1679904361
Name:EVANS, CARRIE (LPCC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:BEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S, LICDC
Mailing Address - Street 1:924 TALUS DR
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1414
Mailing Address - Country:US
Mailing Address - Phone:513-266-9581
Mailing Address - Fax:
Practice Address - Street 1:924 TALUS DR
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1414
Practice Address - Country:US
Practice Address - Phone:513-266-9581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000112101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0176788Medicaid