Healthcare Provider Details

I. General information

NPI: 1104648005
Provider Name (Legal Business Name): WEEVOLVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 GOLD HILL RD # 1010
FORT MILL SC
29708-7977
US

IV. Provider business mailing address

855 GOLD HILL RD # 1010
FORT MILL SC
29708-7977
US

V. Phone/Fax

Practice location:
  • Phone: 704-584-9666
  • Fax:
Mailing address:
  • Phone: 704-584-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAILAH FAGGART
Title or Position: OWNER
Credential:
Phone: 704-305-9703