Provider Demographics
NPI:1912643313
Name:EVERGREENE, EMMA (LMSW-CC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:EVERGREENE
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NORTHERN RD
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2040
Mailing Address - Country:US
Mailing Address - Phone:207-764-4756
Mailing Address - Fax:207-540-1091
Practice Address - Street 1:8 NORTHERN RD
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2040
Practice Address - Country:US
Practice Address - Phone:207-764-4756
Practice Address - Fax:207-540-1091
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor