Provider Demographics
NPI:1013231265
Name:EVANS, MARILYN (LCPC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 THEODORE GREEN BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3042
Mailing Address - Country:US
Mailing Address - Phone:301-885-9760
Mailing Address - Fax:301-753-1919
Practice Address - Street 1:10515 THEODORE GREEN BLVD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3042
Practice Address - Country:US
Practice Address - Phone:301-873-4593
Practice Address - Fax:301-753-1919
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036797400Medicaid