Provider Demographics
NPI:1255641874
Name:EVANS, MARSHA DELOIS (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:DELOIS
Last Name:EVANS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10195 MAIN ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3415
Mailing Address - Country:US
Mailing Address - Phone:703-591-9600
Mailing Address - Fax:703-591-9656
Practice Address - Street 1:10195 MAIN ST
Practice Address - Street 2:SUITE N
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3415
Practice Address - Country:US
Practice Address - Phone:703-591-9600
Practice Address - Fax:703-591-9656
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-16
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health