| Evolution Therapeutic Services | |
|
15401 Wylie Rd Brandywine MD 20613-6216 | |
| (202) 374-0609 | |
| (301) 808-6562 |
| Full Name | Evolution Therapeutic Services |
|---|---|
| Speciality | Social Worker |
| Location | 15401 Wylie Rd, Brandywine, Maryland |
| Authorized Official Name and Position | Stacey Valerie Ferguson (MANAGER) |
| Authorized Official Contact | 2408993473 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolution Therapeutic Services 15401 Wylie Rd Brandywine MD 20613-6216 Ph: (202) 374-0609 | Evolution Therapeutic Services 15401 Wylie Rd Brandywine MD 20613-6216 Ph: (202) 374-0609 |
| NPI Number | 1457085904 |
|---|---|
| Provider Enumeration Date | 07/11/2022 |
| Last Update Date | 07/11/2022 |
| Certification Date | 07/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457085904 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (NU) | Primary |
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