MEDICARE: EVOLVING CHANGES COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	101YM0800X	Mental Health Counselor
3	103TC0700X	Clinical Psychologist
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1063235604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVING CHANGES COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	19074 LISTER AVE
Second Line	:
City	:	EASTPOINTE
State	:	MI
Zip	:	48021-2740
Country	:	US
Telephone Number	:	313-888-7863
Fax Number	:

Provider Business Practice Location Address
First Line	:	18600 FLORENCE ST STE C23
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-6600
Country	:	US
Telephone Number	:	313-888-7863
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAKEITA COBB
Credential	:	LMSW
Telephone Number	:	313-805-0384

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	10/24/2025

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