Healthcare Provider Details

I. General information

NPI: 1447730890
Provider Name (Legal Business Name): EVERGREEN TREATMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PULASKI HWY
HAVRE DE GRACE MD
21078-2127
US

IV. Provider business mailing address

7 GUINEVERE CT
ROSEDALE MD
21237-4030
US

V. Phone/Fax

Practice location:
  • Phone: 443-760-1754
  • Fax:
Mailing address:
  • Phone: 443-760-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: ERICA MARIE PARKER
Title or Position: OWNER
Credential: CSC-AD
Phone: 410-273-9300