Provider Demographics
NPI:1922882950
Name:EVISION MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:EVISION MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHALITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-739-2084
Mailing Address - Street 1:4806 MANTLEWOOD WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3646
Mailing Address - Country:US
Mailing Address - Phone:443-739-2084
Mailing Address - Fax:
Practice Address - Street 1:1416 E BIDDLE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2834
Practice Address - Country:US
Practice Address - Phone:443-739-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVISION MENTAL HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility