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General NPI Number Information
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NPI Number | 1952862971
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Entity Type | Organization
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Legal Business Name | EVOLVE PSYCHOTHERAPY
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Dates
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Enumeration Date | 03/31/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 204 LAFAYETTE ST
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City | SALEM
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State | MA
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Zip | 01970-4721
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Country | US
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Telephone | 603-531-3704
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Fax | 978-564-7541
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Provider Business Mailing Address
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Address Line | 204 LAFAYETTE ST
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City | SALEM
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State | MA
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Zip | 01970-4721
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Country | US
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Telephone | 603-531-3704
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Fax | 978-564-7541
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEBRA MILLS
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Credential | MA, LMHC, LADC-I
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Telephone | 603-531-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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