Provider Demographics
NPI:1790368181
Name:EVOLVE PROFESSIONAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:EVOLVE PROFESSIONAL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-734-0199
Mailing Address - Street 1:111 WALKER DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-2310
Mailing Address - Country:US
Mailing Address - Phone:814-734-0199
Mailing Address - Fax:814-734-0196
Practice Address - Street 1:111 WALKER DR UNIT A
Practice Address - Street 2:
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16412-2310
Practice Address - Country:US
Practice Address - Phone:814-734-0199
Practice Address - Fax:814-734-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty