Healthcare Provider Details

I. General information

NPI: 1992584908
Provider Name (Legal Business Name): EVOLVE WELLNESS VANCOUVER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 8TH ST STE 110
VANCOUVER WA
98660-3294
US

IV. Provider business mailing address

101 E 8TH ST STE 110
VANCOUVER WA
98660-3294
US

V. Phone/Fax

Practice location:
  • Phone: 360-960-0431
  • Fax:
Mailing address:
  • Phone: 360-960-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA C CULVER
Title or Position: CEO
Credential: LICSW
Phone: 503-558-6804