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General NPI Number Information
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NPI Number | 1235425422
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Entity Type | Individual
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Provider Name | BELINDA DIANNE EVANS EBIO LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/25/2011
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 15200 E JEFFERSON AVE STE 101F
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-2055
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Country | US
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Telephone | 313-610-8267
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Fax | 313-861-8503
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Provider Business Mailing Address
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Address Line | 15200 E. JEFFERSON STE, 101F SUITE 101F
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-2055
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Country | US
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Telephone | 313-610-8267
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Fax | 313-861-8506
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801063120
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License Number State | MI
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