Basic Information
| Provider Information | |||||||||
| NPI: | 1982626305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPC,CSAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 SANGERS LN | ||||||||
| Address2: | |||||||||
| City: | STAUNTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244016712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408873200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 85 SANGERS LN | ||||||||
| Address2: | |||||||||
| City: | STAUNTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244016712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408873200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 0710101654 | VA | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 0701003227 | VA | X | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 275732 | 01 | VA | ANTHEM | OTHER | 087803 | 01 | VA | SENTARA | OTHER |