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Individual

GABRIEL MATTHIAS EVANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LLBSW

Contact information

Practice address
310 GLOCHESKI DR, MANISTEE, MI 49660-2639
(877) 398-2013
Mailing address
3840 BLUEBERRY LN, HONOR, MI 49640-9754

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802086349
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6802086349
STATE OF MICHIGAN
MI
Enumeration date
08/25/2011
Last updated
08/25/2011
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