Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 442 | WV |
Y | 103T00000X | Psychologist | 442 | WV |
N | 103TS0200X | School Psychologist | 22037 | WV |
NPI | 1043271232 |
---|---|
Provider Name | Elizabeth G Evans |
First Address | Huntington, WV 25701-3656 |
Second Address | Huntington, WV 25701-3656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 19/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0163537001 | (05) | WV |
0813712 | (05) | OH |
R35200 | (02) | WV |