Provider Demographics
NPI:1417717141
Name:EVOLVE COMMUNITY CONSULTING
Entity Type:Organization
Organization Name:EVOLVE COMMUNITY CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE MANAGER/PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-712-7443
Mailing Address - Street 1:3423 STONY SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5437
Mailing Address - Country:US
Mailing Address - Phone:502-709-9589
Mailing Address - Fax:
Practice Address - Street 1:3423 STONY SPRING CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5437
Practice Address - Country:US
Practice Address - Phone:502-709-9589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty