Provider Demographics
NPI:1568617785
Name:EVANS, CALESHA TAMAR
Entity Type:Individual
Prefix:
First Name:CALESHA
Middle Name:TAMAR
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 PINYON CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2410
Mailing Address - Country:US
Mailing Address - Phone:443-803-8382
Mailing Address - Fax:
Practice Address - Street 1:13 PINYON CT
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-2410
Practice Address - Country:US
Practice Address - Phone:443-803-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker