Healthcare Provider Details

I. General information

NPI: 1396583399
Provider Name (Legal Business Name): EVOLVE THERAPEUTICS AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 PORCHER ST
DOVER DE
19901-5273
US

IV. Provider business mailing address

278 PORCHER ST
DOVER DE
19901-5273
US

V. Phone/Fax

Practice location:
  • Phone: 302-264-0918
  • Fax:
Mailing address:
  • Phone: 302-264-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KELLY EARL
Title or Position: CO-FOUNDER
Credential: LCSW
Phone: 302-264-0918