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General NPI Number Information
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NPI Number | 1366216301
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Entity Type | Organization
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Legal Business Name | EVOLUTION THERAPISTS LLC
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 70 BRECKENRIDGE DR
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-3266
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Country | US
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Telephone | 609-416-1276
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Fax |
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Provider Business Mailing Address
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Address Line | 2355 WESTWOOD BLVD # 537
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City | LOS ANGELES
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State | CA
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Zip | 90064-2109
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Country | US
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Telephone | 856-313-8945
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALESSANDRO NICOLACI
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Credential |
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Telephone | 856-313-8945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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