Healthcare Provider Details

I. General information

NPI: 1477433373
Provider Name (Legal Business Name): EVOLUTIONARY WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 ATLANTIC AVE STE 208
MANASQUAN NJ
08736-1067
US

IV. Provider business mailing address

1913 ATLANTIC AVE STE 208
MANASQUAN NJ
08736-1067
US

V. Phone/Fax

Practice location:
  • Phone: 732-996-5632
  • 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: MS. HANNAH HAIMANN
Title or Position: PRIMARY COUNSELOR
Credential: LPC
Phone: 732-996-5632