Provider Demographics
NPI:1962688341
Name:EVOLVE THERAPEUTIC COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:EVOLVE THERAPEUTIC COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-224-7986
Mailing Address - Street 1:PO BOX 7429
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0429
Mailing Address - Country:US
Mailing Address - Phone:757-224-7986
Mailing Address - Fax:757-224-8321
Practice Address - Street 1:2021B CUNNINGHAM DR
Practice Address - Street 2:SUITE 2
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3326
Practice Address - Country:US
Practice Address - Phone:757-224-7986
Practice Address - Fax:757-224-8321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness