Individual
STEPHANIE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3280 MITCHELL BLVD, MOODY AFB, GA 31699-1580
(229) 257-2778
Mailing address
4937 US HIGHWAY 98 N # 9101, LAKELAND, FL 33809-3610
(813) 527-8976
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
102L00000X
Psychoanalyst
SW16883
FL
104100000X
Social Worker
SW16883
FL
1041C0700X
Clinical Social Worker
Primary
SW16883
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112077100
—
FL
Enumeration date
04/25/2017
Last updated
06/13/2024
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