Healthcare Provider Details

I. General information

NPI: 1588498760
Provider Name (Legal Business Name): 180 EVOLUTION PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PAVERSTONE DR STE 12
RALEIGH NC
27615-4708
US

IV. Provider business mailing address

901 PAVERSTONE DR BOX 12
RALEIGH NC
27615-4708
US

V. Phone/Fax

Practice location:
  • Phone: 919-995-8995
  • Fax: 984-202-2089
Mailing address:
  • Phone: 919-995-8995
  • Fax: 984-202-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YAZMEEN NILAJA IRVING
Title or Position: OWNER & PROVIDER
Credential: LCMHC
Phone: 919-995-8995