Organization
EVERGREEN THERAPY GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE RIZK BAVENDER LCSW-C (OWNER AND PSYCHOTHERAPIST)
(240) 478-8092
Entity
Organization
Contact information
Practice address
11 BYTE CT STE C, FREDERICK, MD 21702-8718
(240) 478-8092
Mailing address
20156 CAMELLIA CROSSE LN, ESTERO, FL 33928-4062
(240) 478-8092
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
12/22/2023
Last updated
12/22/2023
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