Provider Demographics
NPI:1487848834
Name:EVANS ALBURY, LISA (LGSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:EVANS ALBURY
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:ALBURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGSW
Mailing Address - Street 1:1400 MERCANTILE LN
Mailing Address - Street 2:232
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5341
Mailing Address - Country:US
Mailing Address - Phone:301-583-0001
Mailing Address - Fax:301-583-3403
Practice Address - Street 1:1400 MERCANTILE LN
Practice Address - Street 2:232
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5341
Practice Address - Country:US
Practice Address - Phone:301-583-0001
Practice Address - Fax:301-583-3403
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG11966104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker