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NPI Code Detail

MEDICARE: EVOLUTION OF SELF

MEDICARE: EVOLUTION OF SELF
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1255120978
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVOLUTION OF SELF
Provider Business Mailing Address
First Line : 701 GREEN VALLEY RD STE 100
Second Line : #330
City : GREENSBORO
State : NC
Zip : 27408-7096
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 701 GREEN VALLEY RD STE 100
Second Line : ROOM 330
City : GREENSBORO
State : NC
Zip : 27408-7096
Country : US
Telephone Number : 336-618-7697
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DOMINIQUE SHAMBERGER
Credential :
Telephone Number : 336-618-7697
Provider Enumeration Date : 05/01/2025
Last Update Date : 11/19/2025

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Directions to “EVOLUTION OF SELF ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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