| Evolution Clinical Counseling and Services | |
|
149c Green St Grenada MS 38901-2618 | |
| (662) 614-4441 | |
| (601) 510-7558 |
| Full Name | Evolution Clinical Counseling and Services |
|---|---|
| Speciality | Social Worker |
| Location | 149c Green St, Grenada, Mississippi |
| Authorized Official Name and Position | Angela D. Miller (CLINICIAN/OWNER) |
| Authorized Official Contact | 6626144441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolution Clinical Counseling and Services 751 Choctaw St Grenada MS 38901-5317 Ph: (662) 614-4441 | Evolution Clinical Counseling and Services 149c Green St Grenada MS 38901-2618 Ph: (662) 614-4441 |
| NPI Number | 1730043423 |
|---|---|
| Provider Enumeration Date | 12/16/2025 |
| Last Update Date | 12/16/2025 |
| Certification Date | 12/16/2025 |
| Medicare PECOS PAC ID | 1759860190 |
|---|---|
| Medicare Enrollment ID | O20260206000509 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730043423 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | () | Primary |
| Provider Name | Angela Miller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871068395 PECOS PAC ID: 0840710281 Enrollment ID: I20250228000150 |
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