Healthcare Provider Details

I. General information

NPI: 1972181527
Provider Name (Legal Business Name): EVERGREEN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 DERBY ST UNIT 38
HINGHAM MA
02043-4007
US

IV. Provider business mailing address

846 E 5TH ST APT 1
BOSTON MA
02127-6593
US

V. Phone/Fax

Practice location:
  • Phone: 708-431-9972
  • Fax:
Mailing address:
  • Phone: 708-431-9972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RACHEL FOLLIS
Title or Position: OWNER/PROVIDER
Credential: LMHC
Phone: 708-431-9972