| Evolutionary Intervention Llc | |
|
17348 W 12 Mile Rd Suite 106 Southfield MI 48076-2120 | |
| (888) 492-9386 | |
| (888) 492-9386 |
| Full Name | Evolutionary Intervention Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 17348 W 12 Mile Rd, Southfield, Michigan |
| Authorized Official Name and Position | Sharon C Jackson (OWNER) |
| Authorized Official Contact | 8884929386 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolutionary Intervention Llc Po Box 760224 Lathrup Village MI 48076-0224 Ph: () - | Evolutionary Intervention Llc 17348 W 12 Mile Rd Suite 106 Southfield MI 48076-2120 Ph: (888) 492-9386 |
| NPI Number | 1679846505 |
|---|---|
| Provider Enumeration Date | 02/23/2012 |
| Last Update Date | 05/20/2021 |
| Certification Date | 05/20/2021 |
| Medicare PECOS PAC ID | 0244646610 |
|---|---|
| Medicare Enrollment ID | O20210309002954 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679846505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Sharon D Rutledge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891852687 PECOS PAC ID: 3476694183 Enrollment ID: I20100104000106 |
| Provider Name | Janet Okagbue-reaves |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427270354 PECOS PAC ID: 6305061524 Enrollment ID: I20140702001085 |
| Provider Name | Evon Foster |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1104121185 PECOS PAC ID: 3375968159 Enrollment ID: I20200811001177 |
| Provider Name | Tonya Pittman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154095123 PECOS PAC ID: 3779988571 Enrollment ID: I20210817001999 |
| Provider Name | Karen Larkins |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124571963 PECOS PAC ID: 6507216298 Enrollment ID: I20231220004067 |
| Provider Name | Jasmine Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215578745 PECOS PAC ID: 9234589615 Enrollment ID: I20231227002280 |
| Provider Name | Sharon Windfrey |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245402668 PECOS PAC ID: 2860803681 Enrollment ID: I20231228001209 |
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