Provider Demographics
NPI:1023610086
Name:MARSAW EVANS, EUNICE MONIQUE
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:MONIQUE
Last Name:MARSAW 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 1:1405 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-3748
Mailing Address - Country:US
Mailing Address - Phone:160-180-7471
Mailing Address - Fax:
Practice Address - Street 1:1405 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-3748
Practice Address - Country:US
Practice Address - Phone:160-180-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM5084104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker