Provider Demographics
NPI:1194076323
Name:EVANS, FARAH MARIA (LCPC)
Entity type:Individual
Prefix:
First Name:FARAH
Middle Name:MARIA
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8317
Mailing Address - Country:US
Mailing Address - Phone:410-296-2004
Mailing Address - Fax:
Practice Address - Street 1:1055 TAYLOR AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8317
Practice Address - Country:US
Practice Address - Phone:410-296-2004
Practice Address - Fax:410-296-0094
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4226101YP2500X
MD13-9188101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLC4226OtherBOARD OF PROFESSIONAL COUNSELORS & THERAPIST