Provider Demographics
NPI:1699315143
Name:EVANS, JENNIFER IKEA (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:IKEA
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 RAMSGATE PL
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2155
Mailing Address - Country:US
Mailing Address - Phone:240-640-7033
Mailing Address - Fax:
Practice Address - Street 1:US ARMY MEDDAC BAVARIA PSC 411 UNIT 28037 APO, AE 091
Practice Address - Street 2:US BAVARIA
Practice Address - City:BAVARIA
Practice Address - State:US BAVARIA
Practice Address - Zip Code:81735
Practice Address - Country:DE
Practice Address - Phone:011-496-3719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25593104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical