Healthcare Provider Details

I. General information

NPI: 1780951467
Provider Name (Legal Business Name): JESSICA L EVANS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E CHURCHVILLE RD
BEL AIR MD
21014-3442
US

IV. Provider business mailing address

746 REEDY CIR
BEL AIR MD
21014-6815
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-9500
  • Fax:
Mailing address:
  • Phone: 410-714-3022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2578
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: