Provider Demographics
NPI:1104928696
Name:EVANS, KAREN RUTH (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RUTH
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 1:7518 VELVET ANTLER DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1918
Mailing Address - Country:US
Mailing Address - Phone:804-739-5177
Mailing Address - Fax:
Practice Address - Street 1:6851 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-5308
Practice Address - Country:US
Practice Address - Phone:804-715-3215
Practice Address - Fax:804-715-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040052651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904005265OtherLICENSED CLINICAL SOCIAL
VA008443L40Medicare ID - Type Unspecified