Provider Demographics
NPI:1689122830
Name:EVOLVE COUNSELING & HOLISTIC WELLNESS LLC
Entity Type:Organization
Organization Name:EVOLVE COUNSELING & HOLISTIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:517-712-9736
Mailing Address - Street 1:513 HUME BLVD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4247
Mailing Address - Country:US
Mailing Address - Phone:517-712-9736
Mailing Address - Fax:
Practice Address - Street 1:513 HUME BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4247
Practice Address - Country:US
Practice Address - Phone:517-712-9736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty