Healthcare Provider Details

I. General information

NPI: 1255176707
Provider Name (Legal Business Name): EVOLVE COUNSELING AND TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5340 E MAIN ST STE 106
COLUMBUS OH
43213-2574
US

IV. Provider business mailing address

5340 E MAIN ST STE 106
COLUMBUS OH
43213-2574
US

V. Phone/Fax

Practice location:
  • Phone: 614-845-5018
  • Fax: 614-845-5019
Mailing address:
  • Phone: 614-845-5018
  • Fax: 614-845-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. KIM T TANDANPOLIE
Title or Position: EXECUTIVE DIRECTOR
Credential: RN
Phone: 614-537-4206