Provider Demographics
NPI:1962078584
Name:EVANS, DAIJAHNAE ALEXIA (N/A)
Entity type:Individual
Prefix:
First Name:DAIJAHNAE
Middle Name:ALEXIA
Last Name:EVANS
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:DAIJAHNAE
Other - Middle Name:ALEXIA
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:858 DESHON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2936
Mailing Address - Country:US
Mailing Address - Phone:678-315-4136
Mailing Address - Fax:
Practice Address - Street 1:2810 PREMIERE PKWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5014
Practice Address - Country:US
Practice Address - Phone:866-523-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician