Provider Demographics
NPI:1104648005
Name:WEEVOLVE LLC
Entity type:Organization
Organization Name:WEEVOLVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAILAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-305-9703
Mailing Address - Street 1:855 GOLD HILL RD # 1010
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7977
Mailing Address - Country:US
Mailing Address - Phone:704-584-9666
Mailing Address - Fax:
Practice Address - Street 1:855 GOLD HILL RD # 1010
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7977
Practice Address - Country:US
Practice Address - Phone:704-584-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174200000XOther Service ProvidersMeals
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care