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General NPI Number Information
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NPI Number | 1588498760
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Entity Type | Organization
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Legal Business Name | 180 EVOLUTION PLLC
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Dates
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Enumeration Date | 08/29/2024
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 901 PAVERSTONE DR STE 12
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City | RALEIGH
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State | NC
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Zip | 27615-4708
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Country | US
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Telephone | 919-995-8995
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Fax | 984-202-2089
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Provider Business Mailing Address
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Address Line | 901 PAVERSTONE DR BOX 12
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City | RALEIGH
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State | NC
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Zip | 27615-4708
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Country | US
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Telephone | 919-995-8995
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Fax | 984-202-2089
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Authorized Official
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Title or Position | OWNER & PROVIDER
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Name | YAZMEEN NILAJA IRVING
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Credential | LCMHC
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Telephone | 919-995-8995
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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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Taxonomy #2
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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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