Provider Demographics
NPI:1891908380
Name:EVANS, SUSAN VAN GIESEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:VAN GIESEN
Last Name:EVANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 BROOKSIDE PKWY
Mailing Address - Street 2:SUITE 545
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-3718
Mailing Address - Country:US
Mailing Address - Phone:678-762-0606
Mailing Address - Fax:
Practice Address - Street 1:3625 BROOKSIDE PKWY
Practice Address - Street 2:SUITE 545
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-3718
Practice Address - Country:US
Practice Address - Phone:678-762-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical