Provider Demographics
NPI:1013428721
Name:EVOLVE INTERNAL WELLNESS AND COUNSELING, LLC
Entity Type:Organization
Organization Name:EVOLVE INTERNAL WELLNESS AND COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICS, THERAPIST AND OWNER OF EVOLVE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:CALANTHA
Authorized Official - Last Name:CARREIRO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-455-2428
Mailing Address - Street 1:14 HAVEN ROAD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:603-455-2428
Mailing Address - Fax:617-706-2603
Practice Address - Street 1:14 HAVEN ROAD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:603-455-2428
Practice Address - Fax:617-706-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1171421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty