| 180 Evolution Pllc | |
|
901 Paverstone Dr Ste 12 Raleigh NC 27615-4708 | |
| (919) 995-8995 | |
| (984) 202-2089 |
| Full Name | 180 Evolution Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 901 Paverstone Dr Ste 12, Raleigh, North Carolina |
| Authorized Official Name and Position | Yazmeen Nilaja Irving (OWNER & PROVIDER) |
| Authorized Official Contact | 9199958995 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 180 Evolution Pllc 901 Paverstone Dr Box 12 Raleigh NC 27615-4708 Ph: (919) 995-8995 | 180 Evolution Pllc 901 Paverstone Dr Ste 12 Raleigh NC 27615-4708 Ph: (919) 995-8995 |
| NPI Number | 1588498760 |
|---|---|
| Provider Enumeration Date | 08/29/2024 |
| Last Update Date | 08/29/2024 |
| Certification Date | 08/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588498760 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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