Basic Information
| Provider Information | |||||||||
| NPI: | 1497484661 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVOLVING EVE THERAPEUTIC COLLABORATIVE PLLC | ||||||||
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| Address1: | 8601 SIX FORKS RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276152965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193419006 | ||||||||
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| Address1: | 8601 SIX FORKS RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276152965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193419006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2022 | ||||||||
| LastUpdateDate: | 06/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | BISHOP | ||||||||
| AuthorizedOfficialFirstName: | SARINIA | ||||||||
| AuthorizedOfficialMiddleName: | SHERELL | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9193419006 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW, LCAS | ||||||||
| NPICertificationDate: | 06/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.