Healthcare Provider Details

I. General information

NPI: 1558289975
Provider Name (Legal Business Name): EVISION MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 1/2 SUITE A HARFORD ROAD
BALTIMORE MD
21214
US

IV. Provider business mailing address

414 WATER ST APT 2509 APT 2509
BALTIMORE MD
21202-3284
US

V. Phone/Fax

Practice location:
  • Phone: 443-739-2084
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHALITA SMITH
Title or Position: OWNER
Credential:
Phone: 443-739-2084