MEDICARE: EVOLUTION OF SELF: COUNSELING AND CONSULTING LLC

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1700511342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLUTION OF SELF: COUNSELING AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	3519 PELHAM RD STE 107
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4182
Country	:	US
Telephone Number	:	864-664-2764
Fax Number	:

Provider Business Practice Location Address
First Line	:	3519 PELHAM RD STE 107
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29615-4182
Country	:	US
Telephone Number	:	864-664-2764
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MRS. THERESA LYNN WHEELER
Credential	:	MS, LPC/S, LAC/S,
Telephone Number	:	864-664-2764

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	01/22/2026

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