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General NPI Number Information
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NPI Number | 1679357602
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Entity Type | Organization
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Legal Business Name | EVISION MENTAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1515 MARTIN BLVD STE 102
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City | BALTIMORE
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State | MD
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Zip | 21220-4103
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Country | US
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Telephone | 443-739-2048
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Fax |
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Provider Business Mailing Address
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Address Line | 4806 MANTLEWOOD WAY APT 102
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City | ABERDEEN
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State | MD
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Zip | 21001-3646
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Country | US
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Telephone | 443-739-2084
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHALITA SMITH
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Credential |
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Telephone | 437-739-2084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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