Provider Demographics
NPI:1578970778
Name:EVOLUTION COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:EVOLUTION COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:954-850-0511
Mailing Address - Street 1:915 OAKFIELD DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4933
Mailing Address - Country:US
Mailing Address - Phone:954-850-0511
Mailing Address - Fax:813-681-2208
Practice Address - Street 1:915 OAKFIELD DR
Practice Address - Street 2:SUITE E
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4933
Practice Address - Country:US
Practice Address - Phone:954-850-0511
Practice Address - Fax:813-681-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8725251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health