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General NPI Number Information
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NPI Number | 1689122830
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Entity Type | Organization
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Legal Business Name | EVOLVE COUNSELING & HOLISTIC WELLNESS LLC
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 513 HUME BLVD
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City | LANSING
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State | MI
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Zip | 48917-4247
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Country | US
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Telephone | 517-712-9736
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Fax |
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Provider Business Mailing Address
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Address Line | 513 HUME BLVD
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City | LANSING
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State | MI
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Zip | 48917-4247
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Country | US
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Telephone | 517-712-9736
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KELLY ROBERSON
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Credential | LPC
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Telephone | 517-712-9736
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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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