Provider Demographics
NPI:1932875382
Name:EVANS, MELANIE (LCPC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:WALLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGPC
Mailing Address - Street 1:604 SOLAREX CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7005
Mailing Address - Country:US
Mailing Address - Phone:443-761-5245
Mailing Address - Fax:
Practice Address - Street 1:604 SOLAREX CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7005
Practice Address - Country:US
Practice Address - Phone:443-761-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional