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General NPI Number Information
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NPI Number | 1922320100
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Entity Type | Individual
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Provider Name | MICHELLE EVANS LCPC, LPC
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Gender | Female
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 109 LA GRANGE AVE SUITE 103
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City | LA PLATA
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State | MD
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Zip | 20646-9592
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Country | US
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Telephone | 301-535-4603
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1603
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City | LA PLATA
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State | MD
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Zip | 20646-1603
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Country | US
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Telephone | 301-535-4603
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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 | LC2364
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License Number State | MD
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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 | PRC13950
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License Number State | DC
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