Provider Demographics
NPI:1588498760
Name:180 EVOLUTION PLLC
Entity type:Organization
Organization Name:180 EVOLUTION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:YAZMEEN
Authorized Official - Middle Name:NILAJA
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:919-995-8995
Mailing Address - Street 1:901 PAVERSTONE DR
Mailing Address - Street 2:BOX 12
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4708
Mailing Address - Country:US
Mailing Address - Phone:919-995-8995
Mailing Address - Fax:984-202-2089
Practice Address - Street 1:901 PAVERSTONE DR STE 12
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4708
Practice Address - Country:US
Practice Address - Phone:919-995-8995
Practice Address - Fax:984-202-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)