Healthcare Provider Details

I. General information

NPI: 1164289484
Provider Name (Legal Business Name): EVOLVE ADDICTION RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 WYOMING AVE
KINGSTON PA
18704-3831
US

IV. Provider business mailing address

671 WYOMING AVE
KINGSTON PA
18704-3831
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-4205
  • Fax: 570-288-4889
Mailing address:
  • Phone: 570-288-4205
  • Fax: 570-288-4889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALYSSA ZELSNACK
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 570-288-4205