Basic Information
| Provider Information | |||||||||
| NPI: | 1811476153 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVOLVE COUNSELING & WELLNESS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 WALNUT ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024601639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172443322 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 W CUMMINGS PARK STE 5400 | ||||||||
| Address2: | |||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018016385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812812348 | ||||||||
| FaxNumber: | 7812812643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2018 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | RANCOURT | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER, LMHC, LADC | ||||||||
| AuthorizedOfficialTelephone: | 7812812348 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMHC, LADC | ||||||||
| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 6452 | MA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.