Provider Demographics
NPI:1386460996
Name:EVANS, COLEY LEE IV
Entity type:Individual
Prefix:MR
First Name:COLEY
Middle Name:LEE
Last Name:EVANS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GADSDENBORO ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1849
Mailing Address - Country:US
Mailing Address - Phone:404-772-1055
Mailing Address - Fax:
Practice Address - Street 1:5 GADSDENBORO ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1849
Practice Address - Country:US
Practice Address - Phone:404-772-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst