MEDICARE: EVOLVE & EMPOWER COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1902768500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE & EMPOWER COUNSELING LLC

Provider Business Mailing Address
First Line	:	2505 TRIBBLE GATES DR
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-5034
Country	:	US
Telephone Number	:	770-919-6106
Fax Number	:

Provider Business Practice Location Address
First Line	:	4171 MARIETTA ST
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2696
Country	:	US
Telephone Number	:	770-919-6106
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KAREN SMITHSON
Credential	:	LCSW
Telephone Number	:	678-663-9867

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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