Provider Demographics
NPI:1285316661
Name:EVANS, MELODY MICHELLE (MSW)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:MICHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5468 MOONGATE RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1246
Mailing Address - Country:US
Mailing Address - Phone:863-808-7952
Mailing Address - Fax:
Practice Address - Street 1:3200 SW 34TH AVE STE 701
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8443
Practice Address - Country:US
Practice Address - Phone:877-779-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW16026104100000X
FLSW22080101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker