Provider Demographics
NPI:1235643479
Name:EVANS, ROBERT L III (PHD, LCPC, LPC, MAC,)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:EVANS
Suffix:III
Gender:M
Credentials:PHD, LCPC, LPC, MAC,
Other - Prefix:
Other - First Name:EMPOWERMENT
Other - Middle Name:COUNSELING AND
Other - Last Name:TRAINING SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13106 HAMPTON FARM LN
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5812
Mailing Address - Country:US
Mailing Address - Phone:202-441-7989
Mailing Address - Fax:
Practice Address - Street 1:3200 CRAIN HWY STE 205
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4843
Practice Address - Country:US
Practice Address - Phone:240-448-2475
Practice Address - Fax:240-448-2335
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14040101YP2500X
MDLC3102101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD891005700Medicaid