Healthcare Provider Details

I. General information

NPI: 1679357602
Provider Name (Legal Business Name): EVISION MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MAIN ST
REISTERSTOWN MD
21136-2515
US

IV. Provider business mailing address

414 WATER ST APT 2509
BALTIMORE MD
21202-3284
US

V. Phone/Fax

Practice location:
  • Phone: 443-739-2048
  • Fax:
Mailing address:
  • Phone: 443-739-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHALITA SMITH
Title or Position: OWNER
Credential:
Phone: 437-739-2084