Healthcare Provider Details

I. General information

NPI: 1790680015
Provider Name (Legal Business Name): EVERGRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

18310 MONTGOMERY VILLAGE AVE STE 300-1306
GAITHERSBURG MD
20879-3551
US

IV. Provider business mailing address

18310 MONTGOMERY VILLAGE AVE STE 300-1306
GAITHERSBURG MD
20879-3551
US

V. Phone/Fax

Practice location:
  • Phone: 301-302-0909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: REBEKAH MACHIELA
Title or Position: OWNER
Credential: LCSW-C
Phone: 301-302-0909