Organization
EVERCARE RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GIDEON T FON PMHNP (PRESIDENT)
(443) 676-6123
Entity
Organization
Contact information
Practice address
6 ROCK STORY CT, RANDALLSTOWN, MD 21133-2844
(443) 676-6123
Mailing address
6 ROCK STORY CT, RANDALLSTOWN, MD 21133-2844
(443) 676-6123
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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