Healthcare Provider Details

I. General information

NPI: 1932863446
Provider Name (Legal Business Name): JENNIFER EVANS LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 JOHNSVILLE RD
ELDERSBURG MD
21784-4903
US

IV. Provider business mailing address

6097 OKLAHOMA RD
SYKESVILLE MD
21784-6613
US

V. Phone/Fax

Practice location:
  • Phone: 410-259-4586
  • Fax:
Mailing address:
  • Phone: 410-259-4586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC17125
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: