Provider Demographics
NPI:1700511342
Name:EVOLUTION OF SELF: COUNSELING AND CONSULTING LLC
Entity Type:Organization
Organization Name:EVOLUTION OF SELF: COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC/S, LAC/S,
Authorized Official - Phone:864-664-2764
Mailing Address - Street 1:3519 PELHAM RD STE 105
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4182
Mailing Address - Country:US
Mailing Address - Phone:864-664-2764
Mailing Address - Fax:
Practice Address - Street 1:3519 PELHAM RD STE 105
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4182
Practice Address - Country:US
Practice Address - Phone:864-664-2764
Practice Address - Fax:864-738-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty