Healthcare Provider Details

I. General information

NPI: 1316865116
Provider Name (Legal Business Name): EVOLVE LEARN & GROW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 KEY WEST MEWS
CARY NC
27513-4186
US

IV. Provider business mailing address

614 KEY WEST MEWS
CARY NC
27513-4186
US

V. Phone/Fax

Practice location:
  • Phone: 984-290-6801
  • Fax:
Mailing address:
  • Phone: 984-290-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: PENINNAH DIXON
Title or Position: MANAGING PARTNER
Credential:
Phone: 984-290-6801