Provider Demographics
NPI:1811697238
Name:SCOVENS, CYRIL MAXWELL (LCADC)
Entity type:Individual
Prefix:MR
First Name:CYRIL
Middle Name:MAXWELL
Last Name:SCOVENS
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 GLENROCK RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4720
Mailing Address - Country:US
Mailing Address - Phone:443-835-8808
Mailing Address - Fax:218-422-7223
Practice Address - Street 1:608 GLENROCK RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4720
Practice Address - Country:US
Practice Address - Phone:443-835-8808
Practice Address - Fax:218-422-7223
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA3183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty