Provider Demographics
NPI:1316251549
Name:EVANS, DWIGHT DANIEL (MA, MDIV, LPC)
Entity type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:DANIEL
Last Name:EVANS
Suffix:
Gender:M
Credentials:MA, MDIV, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 IOWA RD
Mailing Address - Street 2:
Mailing Address - City:ALBRIGHTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18210-3622
Mailing Address - Country:US
Mailing Address - Phone:570-401-6378
Mailing Address - Fax:
Practice Address - Street 1:133 SWITZGABEL DR
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7120
Practice Address - Country:US
Practice Address - Phone:570-401-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004180101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional