Healthcare Provider Details

I. General information

NPI: 1073420519
Provider Name (Legal Business Name): EVERGROWN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 TWIN RIVERS RD APT 261
COLUMBIA MD
21044-6553
US

IV. Provider business mailing address

10101 TWIN RIVERS RD APT 261
COLUMBIA MD
21044-6553
US

V. Phone/Fax

Practice location:
  • Phone: 917-822-2588
  • Fax:
Mailing address:
  • Phone: 917-822-2588
  • Fax:

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 State

VIII. Authorized Official

Name: FORAM PARE
Title or Position: OWNER
Credential: LGPC
Phone: 917-822-2588