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General NPI Number Information
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NPI Number | 1104645019
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Entity Type | Organization
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Legal Business Name | EVOLVING YOURSELF THERAPY
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 3103 WILMINGTON RD
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City | NEW CASTLE
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State | PA
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Zip | 16105-1131
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Country | US
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Telephone | 724-542-8716
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Fax | 724-765-2014
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Provider Business Mailing Address
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Address Line | 411 E REYNOLDS ST
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City | NEW CASTLE
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State | PA
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Zip | 16101-4747
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Country | US
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Telephone | 724-542-8716
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Fax | 724-765-2014
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Authorized Official
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Title or Position | OWNER
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Name | CHARITYLYN BRADLEY
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Credential | LPC
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Telephone | 724-542-8716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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