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General NPI Number Information
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NPI Number | 1235643479
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Entity Type | Individual
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Provider Name | ROBERT L EVANS III PHD, LCPC, LPC, MAC,
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Gender | Male
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 3200 CRAIN HWY STE 205
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City | WALDORF
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State | MD
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Zip | 20603-4843
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Country | US
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Telephone | 240-448-2475
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Fax | 240-448-2335
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Provider Business Mailing Address
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Address Line | 13106 HAMPTON FARM LN
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City | BRANDYWINE
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State | MD
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Zip | 20613-5812
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Country | US
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Telephone | 202-441-7989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC14040
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC3102
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License Number State | MD
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