Provider Demographics
NPI:1740903616
Name:EVOLUTION UNLIMITED ACCESS
Entity type:Organization
Organization Name:EVOLUTION UNLIMITED ACCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KHALIMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:POOLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:201-844-5388
Mailing Address - Street 1:1205 BRISTOL STATION CT
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-3091
Mailing Address - Country:US
Mailing Address - Phone:201-844-5388
Mailing Address - Fax:
Practice Address - Street 1:485C US HIGHWAY 1 S STE 350-305
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-3037
Practice Address - Country:US
Practice Address - Phone:732-874-0773
Practice Address - Fax:732-694-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health