Provider Demographics
NPI:1710475272
Name:EVANS, KRISTIE EDWARDS (LGPC)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:EDWARDS
Last Name:EVANS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 INTERNATIONAL CIR STE T125
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1391
Mailing Address - Country:US
Mailing Address - Phone:443-797-0144
Mailing Address - Fax:
Practice Address - Street 1:303 INTERNATIONAL CIR STE T125
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1391
Practice Address - Country:US
Practice Address - Phone:443-797-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP5750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional