Healthcare Provider Details

I. General information

NPI: 1225647811
Provider Name (Legal Business Name): EVOLUTION YOU, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 ELLA JANE LN APT W
CHARLOTTE NC
28273-4782
US

IV. Provider business mailing address

7700 ELLA JANE LN APT W
CHARLOTTE NC
28273-4782
US

V. Phone/Fax

Practice location:
  • Phone: 704-954-8538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEITRA HARRIS
Title or Position: THERAPIST/OWNER
Credential: LCSW, LISW-CP
Phone: 704-200-7983