Provider Demographics
NPI:1497484661
Name:EVOLVING EVE THERAPEUTIC COLLABORATIVE PLLC
Entity Type:Organization
Organization Name:EVOLVING EVE THERAPEUTIC COLLABORATIVE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARINIA
Authorized Official - Middle Name:SHERELL
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS
Authorized Official - Phone:919-341-9006
Mailing Address - Street 1:8601 SIX FORKS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2965
Mailing Address - Country:US
Mailing Address - Phone:919-341-9006
Mailing Address - Fax:
Practice Address - Street 1:8601 SIX FORKS RD STE 400
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2965
Practice Address - Country:US
Practice Address - Phone:919-341-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty