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General NPI Number Information
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NPI Number | 1972350999
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Entity Type | Organization
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Legal Business Name | EVOLVE AURA WELLNESS
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Dates
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Enumeration Date | 05/06/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 152 N HARBOR CITY BLVD STE 100
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City | MELBOURNE
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State | FL
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Zip | 32935-6794
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Country | US
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Telephone | 321-209-1299
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Fax | 321-517-2900
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Provider Business Mailing Address
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Address Line | 152 N HARBOR CITY BLVD #100
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City | WEST MELBOURNE
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State | FL
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Zip | 32904-3661
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Country | US
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Telephone | 321-209-1299
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Fax | 321-517-2900
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Authorized Official
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Title or Position | THERAPIST
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Name | JULINE ALLEN
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Credential | LMHC
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Telephone | 321-209-1299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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