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General NPI Number Information
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NPI Number | 1598260630
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Entity Type | Organization
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Legal Business Name | PERSONAL EVOLUTION LLC
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 430 BELGRADE ST FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19125-2621
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Country | US
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Telephone | 267-764-1997
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Fax |
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Provider Business Mailing Address
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Address Line | 430 BELGRADE ST FL 1
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City | PHILADELPHIA
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State | PA
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Zip | 19125-2621
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Country | US
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Telephone | 267-764-1997
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | KATHERINE GLICK
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Credential | LPC, ACS
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Telephone | 215-469-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00477600
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC009315
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License Number State | PA
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