Provider Demographics
NPI:1649141466
Name:BACKSTROM, EVA ANNIKA (LGPC)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:ANNIKA
Last Name:BACKSTROM
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:ANNIKA
Other - Middle Name:
Other - Last Name:BACKSTROM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8181 MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4929
Mailing Address - Country:US
Mailing Address - Phone:410-505-0062
Mailing Address - Fax:410-650-5893
Practice Address - Street 1:8181 MAIN ST APT 2
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4929
Practice Address - Country:US
Practice Address - Phone:410-505-0062
Practice Address - Fax:410-650-5893
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health