Healthcare Provider Details

I. General information

NPI: 1932782299
Provider Name (Legal Business Name): MELISSA EVANS, LCSW-C, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10433 STEVENSON RD UNIT B
STEVENSON MD
21153-0602
US

IV. Provider business mailing address

2886 STALEY DR
WESTMINSTER MD
21158-2120
US

V. Phone/Fax

Practice location:
  • Phone: 410-963-3839
  • Fax:
Mailing address:
  • Phone: 410-963-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MELISSA EVANS
Title or Position: DIRECTOR
Credential: LCSW-C
Phone: 410-963-3839