Provider Demographics
NPI:1518789023
Name:EVOLVE THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:EVOLVE THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMSW
Authorized Official - Phone:262-902-2189
Mailing Address - Street 1:9308 CHERRY HILL RD, 312
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:240-753-0290
Practice Address - Street 1:9308 CHERRY HILL RD, 312
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1235
Practice Address - Country:US
Practice Address - Phone:240-753-0290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-26
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)