Provider Demographics
NPI:1235425422
Name:EVANS EBIO, BELINDA DIANNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BELINDA
Middle Name:DIANNE
Last Name:EVANS EBIO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 15 MILE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4853
Mailing Address - Country:US
Mailing Address - Phone:586-264-3692
Mailing Address - Fax:586-939-5953
Practice Address - Street 1:2122 15 MILE RD
Practice Address - Street 2:SUITE B
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4853
Practice Address - Country:US
Practice Address - Phone:586-264-3692
Practice Address - Fax:586-939-5953
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8010631201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12188569Medicaid