Provider Demographics
NPI:1619349909
Name:EVANS, CELEVIA
Entity Type:Individual
Prefix:
First Name:CELEVIA
Middle Name:
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 1:357 TOWNE CENTER BLVD., SUITE 100
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4837
Mailing Address - Country:US
Mailing Address - Phone:601-952-0894
Mailing Address - Fax:601-952-0836
Practice Address - Street 1:357 TOWNE CENTER BLVD., SUITE 100
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4837
Practice Address - Country:US
Practice Address - Phone:601-952-0894
Practice Address - Fax:601-952-0836
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM5132104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker