Healthcare Provider Details

I. General information

NPI: 1891673869
Provider Name (Legal Business Name): EVERGREEN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAIN ST
FREEPORT ME
04032-1100
US

IV. Provider business mailing address

PO BOX 102
LISBON FALLS ME
04252-0102
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-8452
  • Fax:
Mailing address:
  • Phone: 207-200-8452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHANIE WORTH
Title or Position: OWNER
Credential: LCSW
Phone: 207-200-8452