Provider Demographics
NPI:1063302156
Name:EVANS, ALICIA (MFT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:EVANS
Suffix:
Gender:X
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1400
Mailing Address - Country:US
Mailing Address - Phone:270-338-0487
Mailing Address - Fax:
Practice Address - Street 1:300 DEAN RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1400
Practice Address - Country:US
Practice Address - Phone:270-338-0487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY299639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health