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General NPI Number Information
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NPI Number | 1396131769
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Entity Type | Organization
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Legal Business Name | EVOLVE COUNSELING, PLLC
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Dates
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Enumeration Date | 04/12/2015
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 423 CRICKET HEARTH RD
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City | SANFORD
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State | NC
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Zip | 27330-6335
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Country | US
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Telephone | 919-656-0596
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Fax |
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Provider Business Mailing Address
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Address Line | 423 CRICKET HEARTH RD
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City | SANFORD
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State | NC
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Zip | 27330-6335
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Country | US
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Telephone | 919-656-0596
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Fax |
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Authorized Official
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Title or Position | OWNER, PROVIDER
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Name | MRS. REAGAN WEST COURLISS
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Credential | M.ED, NCC, LCMHC
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Telephone | 919-656-0596
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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 | 9023
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License Number State | NC
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