Healthcare Provider Details

I. General information

NPI: 1780969865
Provider Name (Legal Business Name): THEONIE PAPPAS EVANS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 N CHARLES ST
BALTIMORE MD
21210-2024
US

IV. Provider business mailing address

5407 N CHARLES ST
BALTIMORE MD
21210-2024
US

V. Phone/Fax

Practice location:
  • Phone: 410-433-8861
  • Fax: 410-433-1249
Mailing address:
  • Phone: 410-433-8861
  • Fax: 410-433-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC3323
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: