Individual
MICHELLE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, LPC
Contact information
Practice address
109 LA GRANGE AVE, SUITE 103, LA PLATA, MD 20646-9592
(301) 535-4603
Mailing address
PO BOX 1603, LA PLATA, MD 20646-1603
(301) 535-4603
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LC2364
MD
101YP2500X
Professional Counselor
PRC13950
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80-0537466
INTERNAL REVENUE SERVICE
MD
Enumeration date
02/16/2010
Last updated
05/09/2013
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