Healthcare Provider Details

I. General information

NPI: 1518671908
Provider Name (Legal Business Name): EVOLVE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7618 CHESTERFIELD WAY
ROSEDALE MD
21237-3370
US

IV. Provider business mailing address

7618 CHESTERFIELD WAY
ROSEDALE MD
21237-3370
US

V. Phone/Fax

Practice location:
  • Phone: 443-415-3571
  • Fax:
Mailing address:
  • Phone: 443-415-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TRACY T HUNT
Title or Position: OWNER
Credential: LCPC
Phone: 443-415-3571