Provider Demographics
NPI:1093248577
Name:EVA LIFE GIVER INC.
Entity Type:Organization
Organization Name:EVA LIFE GIVER INC.
Other - Org Name:DEVAUGHN INTERVENTION TEACH AND TREAT OPTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CAC-AD
Authorized Official - Phone:443-271-8046
Mailing Address - Street 1:5003 ARDMORE WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5004
Mailing Address - Country:US
Mailing Address - Phone:443-271-8046
Mailing Address - Fax:443-873-8958
Practice Address - Street 1:1528 COUNTRY RIDGE LN
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3906
Practice Address - Country:US
Practice Address - Phone:443-271-8046
Practice Address - Fax:410-665-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD570127900Medicaid
MD570127901Medicaid