Healthcare Provider Details

I. General information

NPI: 1316855497
Provider Name (Legal Business Name): AUTUMN DEVORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12318 WHISPERING PINES LN
FROSTBURG MD
21532-3272
US

IV. Provider business mailing address

12318 WHISPERING PINES LN
FROSTBURG MD
21532-3272
US

V. Phone/Fax

Practice location:
  • Phone: 301-707-4919
  • Fax:
Mailing address:
  • Phone: 301-707-4919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2741
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: