Healthcare Provider Details

I. General information

NPI: 1578017091
Provider Name (Legal Business Name): EVELYN ELIZABETH MITCHELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVELYN ELIZABETH JIMENEZ LCPC

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14440 CHERRY LANE CT STE 208
LAUREL MD
20707-4946
US

IV. Provider business mailing address

14440 CHERRY LANE CT STE 208
LAUREL MD
20707-4946
US

V. Phone/Fax

Practice location:
  • Phone: 301-604-1458
  • Fax: 301-604-1459
Mailing address:
  • Phone: 301-604-1458
  • Fax: 301-604-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC8652
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC15202
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: