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General NPI Number Information
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NPI Number | 1265033989
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Entity Type | Organization
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Legal Business Name | EVOLVE GROWTH INITIATIVES LLC
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 588 SAN RAMON VALLEY BLVD, UNIT B/SUITE 110
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City | DANVILLE
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State | CA
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Zip | 94526
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Country | US
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Telephone | 424-290-3354
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Fax |
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Provider Business Mailing Address
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Address Line | 360 N PACIFIC COAST HWY STE 1010
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City | EL SEGUNDO
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State | CA
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Zip | 90245-4413
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Country | US
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Telephone | 424-290-3360
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Fax | 424-290-3355
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Authorized Official
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Title or Position | CFO
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Name | EDDY LAI
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Credential |
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Telephone | 424-290-3341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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