Healthcare Provider Details

I. General information

NPI: 1780539676
Provider Name (Legal Business Name): EVOLVE THERAPY COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 MEADOWS AVE
GRAND BLANC MI
48439-8689
US

IV. Provider business mailing address

4404 MEADOWS AVE
GRAND BLANC MI
48439-8689
US

V. Phone/Fax

Practice location:
  • Phone: 947-225-7654
  • Fax:
Mailing address:
  • Phone: 947-225-7654
  • 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: MR. JOSHUA JAMES SHILLING
Title or Position: OWNER
Credential: SHILLING
Phone: 947-225-7654