Provider Demographics
NPI:1356088389
Name:EVOLVE PSYCH GROUP, PLLC
Entity Type:Organization
Organization Name:EVOLVE PSYCH GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCE
Authorized Official - Phone:631-553-9460
Mailing Address - Street 1:1109 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7501
Mailing Address - Country:US
Mailing Address - Phone:631-553-9460
Mailing Address - Fax:
Practice Address - Street 1:1109 MEADOWLARK LN
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-7501
Practice Address - Country:US
Practice Address - Phone:631-553-9460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)