Healthcare Provider Details

I. General information

NPI: 1184254211
Provider Name (Legal Business Name): EVOLUTION COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 FOREST DR STE 31
ANNAPOLIS MD
21403-1446
US

IV. Provider business mailing address

3737 OAK LN
EDGEWATER MD
21037-3707
US

V. Phone/Fax

Practice location:
  • Phone: 443-214-8414
  • Fax: 443-767-4396
Mailing address:
  • Phone: 443-214-8414
  • Fax: 443-767-4396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHRISTINE M ENGLISH
Title or Position: OWNER
Credential: FOUNDER
Phone: 443-214-8414