Provider Demographics
NPI:1093540593
Name:EVANS, GENEVIEVE ROSETTA (LCMHCA)
Entity type:Individual
Prefix:MISS
First Name:GENEVIEVE
Middle Name:ROSETTA
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 1:2424 COMMERCE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7505
Mailing Address - Country:US
Mailing Address - Phone:252-557-0444
Mailing Address - Fax:
Practice Address - Street 1:2424 COMMERCE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-7505
Practice Address - Country:US
Practice Address - Phone:252-557-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty