Provider Demographics
NPI:1679995500
Name:EVANS, BRANDI (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 COLISEUM BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3714
Mailing Address - Country:US
Mailing Address - Phone:318-443-9339
Mailing Address - Fax:318-443-9116
Practice Address - Street 1:5920 COLISEUM BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3714
Practice Address - Country:US
Practice Address - Phone:318-443-9339
Practice Address - Fax:318-443-9116
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-12
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical