| Evergreen Therapy Llc | |
|
139 Log Canoe Cir Stevensville MD 21666-2127 | |
| (443) 808-1083 | |
| Not Available |
| Full Name | Evergreen Therapy Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 139 Log Canoe Cir, Stevensville, Maryland |
| Authorized Official Name and Position | Amy Louise Gibbs Bennett (CLINICAL MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 4438081083 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Therapy Llc 139 Log Canoe Cir Stevensville MD 21666-2127 Ph: (443) 808-1083 | Evergreen Therapy Llc 139 Log Canoe Cir Stevensville MD 21666-2127 Ph: (443) 808-1083 |
| NPI Number | 1548045859 |
|---|---|
| Provider Enumeration Date | 08/28/2023 |
| Last Update Date | 08/28/2023 |
| Certification Date | 08/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548045859 | NPI | - | NPPES |
| 1376140285 | Other | NPPES |
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