Provider Demographics
NPI:1598511859
Name:EVERGREEN INSIGHT PLLC
Entity type:Organization
Organization Name:EVERGREEN INSIGHT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:VAN SCOYOC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-213-0327
Mailing Address - Street 1:3820 STONEYCREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-9551
Mailing Address - Country:US
Mailing Address - Phone:919-597-9531
Mailing Address - Fax:
Practice Address - Street 1:3820 STONEYCREEK RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-9551
Practice Address - Country:US
Practice Address - Phone:919-597-9531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health