Provider Demographics
NPI:1992689269
Name:EVANS, MECCA DIONNE
Entity type:Individual
Prefix:
First Name:MECCA
Middle Name:DIONNE
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 1:13162 ROUNDOAK WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-0424
Mailing Address - Country:US
Mailing Address - Phone:442-278-8922
Mailing Address - Fax:442-278-8922
Practice Address - Street 1:13162 ROUNDOAK WAY
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-0424
Practice Address - Country:US
Practice Address - Phone:442-278-8922
Practice Address - Fax:442-278-8922
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty