Provider Demographics
NPI:1316257124
Name:EVANS, COLLEEN M (MS, ED, NCC, LPC)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:M
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS, ED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 YOUNGSTOWN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-3539
Mailing Address - Country:US
Mailing Address - Phone:724-691-5222
Mailing Address - Fax:
Practice Address - Street 1:410 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-691-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003975101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional