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General NPI Number Information
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NPI Number | 1245919406
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Entity Type | Organization
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Legal Business Name | EVOLVE BEHAVIORAL HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 6033 BUSHNELL DR
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City | NEW KENT
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State | VA
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Zip | 23124-3034
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Country | US
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Telephone | 518-928-3261
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Fax |
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Provider Business Mailing Address
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Address Line | 6033 BUSHNELL DR
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City | NEW KENT
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State | VA
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Zip | 23124-3034
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Country | US
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Telephone | 518-928-3261
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KERRY RENEE BURNETT
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Credential | MSED, BCBA, LBA
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Telephone | 518-928-3261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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