Healthcare Provider Details

I. General information

NPI: 1477488195
Provider Name (Legal Business Name): EVOLVE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 S TOWNLINE RD
SANDUSKY MI
48471-9723
US

IV. Provider business mailing address

365 S TOWNLINE RD
SANDUSKY MI
48471-9723
US

V. Phone/Fax

Practice location:
  • Phone: 810-837-1613
  • Fax:
Mailing address:
  • Phone: 810-837-1613
  • Fax:

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 State

VIII. Authorized Official

Name: TRACI LYNN WHEELER
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC
Phone: 810-837-1613