Provider Demographics
NPI:1811476153
Name:EVOLVE COUNSELING & WELLNESS LLC
Entity type:Organization
Organization Name:EVOLVE COUNSELING & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMHC, LADC
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LADC
Authorized Official - Phone:781-281-2348
Mailing Address - Street 1:246 WALNUT ST STE 104
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1639
Mailing Address - Country:US
Mailing Address - Phone:617-244-3322
Mailing Address - Fax:
Practice Address - Street 1:800 W CUMMINGS PARK STE 5400
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6385
Practice Address - Country:US
Practice Address - Phone:781-281-2348
Practice Address - Fax:781-281-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6452101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty