Provider Demographics
NPI:1689345357
Name:EVOLUTIONARY SOUL COUNSELING & WELLNESS SERVICES, LLC
Entity Type:Organization
Organization Name:EVOLUTIONARY SOUL COUNSELING & WELLNESS SERVICES, LLC
Other - Org Name:EVOLUTIONARY SOUL COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNACA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:717-357-8230
Mailing Address - Street 1:5010 RITTER RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4828
Mailing Address - Country:US
Mailing Address - Phone:717-357-8230
Mailing Address - Fax:
Practice Address - Street 1:5010 RITTER RD STE 109
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-4828
Practice Address - Country:US
Practice Address - Phone:717-357-8230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)