Healthcare Provider Details

I. General information

NPI: 1831622315
Provider Name (Legal Business Name): EVA LIFE GIVER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4804 YORK RD STE 2
BALTIMORE MD
21212-4401
US

IV. Provider business mailing address

5003 ARDMORE WAY
BALTIMORE MD
21206-5004
US

V. Phone/Fax

Practice location:
  • Phone: 443-271-8046
  • Fax: 443-873-8958
Mailing address:
  • Phone: 443-271-8046
  • Fax: 443-873-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. EVA DEVAUGHN
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, CAC-AD
Phone: 443-271-8046