1588091441 NPI number — DARCIE EVANS LICSW COUNSELING SERVICES

Table of content: (NPI 1588091441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588091441 NPI number — DARCIE EVANS LICSW COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DARCIE EVANS LICSW COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588091441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 GOLDFINCH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANTUCKET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02554-6008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-825-2552
Provider Business Mailing Address Fax Number:
508-825-0831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 GOLDFINCH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANTUCKET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02554-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-825-2552
Provider Business Practice Location Address Fax Number:
508-825-0831
Provider Enumeration Date:
10/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
DARCIE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
508-825-2552

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X , with the licence number:  110335 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1164533402 . This is a "NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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