Provider Demographics
NPI:1164045969
Name:EVERNGAM, MALLEY K HESTER (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MALLEY
Middle Name:K HESTER
Last Name:EVERNGAM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30103 RABBIT HILL RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-6555
Mailing Address - Country:US
Mailing Address - Phone:410-829-7067
Mailing Address - Fax:
Practice Address - Street 1:165 LOG CANOE CIR STE B-3
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2149
Practice Address - Country:US
Practice Address - Phone:443-282-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25087104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker