| Evolution You, Pllc | |
|
7700 Ella Jane Ln Apt W Charlotte NC 28273-4782 | |
| (704) 954-8538 | |
| Not Available |
| Full Name | Evolution You, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7700 Ella Jane Ln Apt W, Charlotte, North Carolina |
| Authorized Official Name and Position | Deitra Harris (THERAPIST/OWNER) |
| Authorized Official Contact | 7042007983 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolution You, Pllc 7700 Ella Jane Ln Apt W Charlotte NC 28273-4782 Ph: () - | Evolution You, Pllc 7700 Ella Jane Ln Apt W Charlotte NC 28273-4782 Ph: (704) 954-8538 |
| NPI Number | 1225647811 |
|---|---|
| Provider Enumeration Date | 07/29/2020 |
| Last Update Date | 07/29/2020 |
| Certification Date | 07/29/2020 |
| Medicare PECOS PAC ID | 8325569478 |
|---|---|
| Medicare Enrollment ID | O20250305004172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225647811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Deitra Harris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679048623 PECOS PAC ID: 3870929870 Enrollment ID: I20200211002497 |
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