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General NPI Number Information
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NPI Number | 1477433373
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Entity Type | Organization
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Legal Business Name | EVOLUTIONARY WELLNESS LLC
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 1913 ATLANTIC AVE STE 208
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City | MANASQUAN
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State | NJ
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Zip | 08736-1067
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Country | US
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Telephone | 732-996-5632
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Fax |
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Provider Business Mailing Address
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Address Line | 1913 ATLANTIC AVE STE 208
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City | MANASQUAN
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State | NJ
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Zip | 08736-1067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRIMARY COUNSELOR
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Name | MS. HANNAH HAIMANN
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Credential | LPC
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Telephone | 732-996-5632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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