Provider Demographics
NPI:1831785641
Name:EVOLVE COUNSELING GROUP
Entity type:Organization
Organization Name:EVOLVE COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-792-0851
Mailing Address - Street 1:8894 STANFORD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5161
Mailing Address - Country:US
Mailing Address - Phone:301-792-0851
Mailing Address - Fax:347-903-6927
Practice Address - Street 1:8894 STANFORD BLVD STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5161
Practice Address - Country:US
Practice Address - Phone:301-792-0851
Practice Address - Fax:347-903-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty