Individual
MARY EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1025 EXECUTIVE PARK BLVD, KINGSPORT, TN 37660-4620
(423) 735-8124
Mailing address
613 LYLE RD, ERWIN, TN 37650-4117
(423) 388-5195
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0904010726
VA
1041C0700X
Clinical Social Worker
Primary
7160
TN
Other
Enumeration date
09/19/2019
Last updated
06/04/2020
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