Individual
ELIJAH B EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PEER SUPPORT CERT.
Contact information
Practice address
1120 W HUTCHINSON AVE, CROWLEY, LA 70526-4124
(337) 250-4263
Mailing address
122A OLIVE BRANCH DR, YOUNGSVILLE, LA 70592-5121
(337) 376-3523
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
011576884
LA
Other
Enumeration date
07/27/2020
Last updated
07/27/2020
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