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General NPI Number Information
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NPI Number | 1265878318
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Entity Type | Organization
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Legal Business Name | MECHELE DE AVILA, LCSW, LLC
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1082 HAVENWOOD DRIVE BACK APARTMENT
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City | BATON ROUGE
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State | LA
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Zip | 70815-6730
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Country | US
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Telephone | 225-366-8606
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Fax | 225-410-0080
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Provider Business Mailing Address
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Address Line | PO BOX 41001
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City | BATON ROUGE
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State | LA
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Zip | 70835
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Country | US
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Telephone | 225-366-8606
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Fax | 225-410-0080
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Authorized Official
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Title or Position | OWNER
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Name | MECHELE DE AVILA EVANS
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Credential | LCSW
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Telephone | 504-453-0216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4065
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License Number State | LA
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