Healthcare Provider Details

I. General information

NPI: 1952223042
Provider Name (Legal Business Name): EVERGREEN HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 HIGH PEAK RD
MONROE VA
24574-2759
US

IV. Provider business mailing address

391 HIGH PEAK RD
MONROE VA
24574-2759
US

V. Phone/Fax

Practice location:
  • Phone: 240-207-8382
  • Fax: 240-207-8382
Mailing address:
  • Phone: 240-207-8382
  • Fax: 240-207-8382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ETHAN JACOB LENZNER
Title or Position: CEO
Credential: LMHC
Phone: 240-207-8382