Provider Demographics
NPI:1568101624
Name:EVOLVE DELIBERATELY, LLC
Entity Type:Organization
Organization Name:EVOLVE DELIBERATELY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THINH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:410-262-9894
Mailing Address - Street 1:2609 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-4116
Mailing Address - Country:US
Mailing Address - Phone:410-262-9894
Mailing Address - Fax:
Practice Address - Street 1:4419 FALLS RD STE D
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1296
Practice Address - Country:US
Practice Address - Phone:410-262-9894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty