Provider Demographics
NPI: | 1285804120 |
---|---|
Name: | EVOLVE CONSULTING |
Entity type: | Organization |
Organization Name: | EVOLVE CONSULTING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CHRISTI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BARTOLOMUCCI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 404-808-3370 |
Mailing Address - Street 1: | 4045 ORCHARD RD SE |
Mailing Address - Street 2: | SUITE 110 |
Mailing Address - City: | SMYRNA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30080-4902 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 404-808-3370 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4045 ORCHARD RD SE |
Practice Address - Street 2: | SUITE 110 |
Practice Address - City: | SMYRNA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30080-4902 |
Practice Address - Country: | US |
Practice Address - Phone: | 404-808-3370 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-03-06 |
Last Update Date: | 2008-03-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 002707 | 103T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty |