Provider Demographics
NPI: | 1265854392 |
---|---|
Name: | MAYE, EVELYN |
Entity Type: | Individual |
Prefix: | |
First Name: | EVELYN |
Middle Name: | |
Last Name: | MAYE |
Suffix: | |
Gender: | F |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1629 K ST NW |
Mailing Address - Street 2: | #300 |
Mailing Address - City: | WASHINGTON |
Mailing Address - State: | DC |
Mailing Address - Zip Code: | 20006-1602 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-899-2210 |
Mailing Address - Fax: | 888-205-3238 |
Practice Address - Street 1: | 9440 MARLBORO AVE STE 330 |
Practice Address - Street 2: | |
Practice Address - City: | UPPER MARLBORO |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20772-3659 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-899-2210 |
Practice Address - Fax: | 888-205-3238 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2014-01-08 |
Last Update Date: | 2023-02-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 699 | 101Y00000X |
DC | CAC11043 | 101YA0400X |
DC | 115023 | 101YP2500X |
DC | PRC14450 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |