Provider Demographics
NPI:1124087481
Name:EVANS, MECHELE DE AVILA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MECHELE
Middle Name:DE AVILA
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MECHELE
Other - Middle Name:ELIZABETH
Other - Last Name:DE AVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSSW
Mailing Address - Street 1:PO BOX 41001
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70835
Mailing Address - Country:US
Mailing Address - Phone:225-366-8606
Mailing Address - Fax:225-410-0080
Practice Address - Street 1:1082 HAVENWOOD DRIVE
Practice Address - Street 2:BACK APARTMENT
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6730
Practice Address - Country:US
Practice Address - Phone:225-366-8606
Practice Address - Fax:225-410-0080
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA400651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1549495Medicaid
LA5X467Medicare ID - Type Unspecified