Organization
EVERGREEN THERAPY LLC
Active
Other names
Evergreen Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
AMY LOUISE GIBBS BENNETT LGPC (CLINICAL MENTAL HEALTH THERAPIST)
(443) 808-1083
Entity
Organization
Contact information
Practice address
139 LOG CANOE CIR, STEVENSVILLE, MD 21666-2127
(443) 808-1083
Mailing address
139 LOG CANOE CIR, STEVENSVILLE, MD 21666-2127
(443) 808-1083
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376140285
NPPES
—
Enumeration date
08/28/2023
Last updated
08/28/2023
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