NPIMap

Organization Active NPI

Evolve Therapuetic Health and Wellness Services

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Bowie, MD
National Provider Identifier
1013579093
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
EVOLVE THERAPUETIC HEALTH AND WELLNESS SERVICES
Practice address
16208 Penterra Way
Bowie, MD 20716-1919
Phone
(301) 996-1677
NPI assigned
Jul 1, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacqueline D Hamilton, LCPCNPI 1629551239
Title
Ceo
Phone
(301) 996-1677

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

16208 Penterra Way
Bowie, MD 20716-1919

Mailing address

16208 Penterra Way
Bowie, MD 20716-1919
Phone (301) 996-1677

Other identifiers 1

IdentifierTypeStateIssuer
4515124MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Evolve Therapuetic Behavioral Health and Wellness Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1013579093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16208 PENTERRA WAY",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207161919",
            "telephone_number": "301-996-1677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16208 PENTERRA WAY",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207161919",
            "telephone_number": "301-996-1677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE THERAPUETIC HEALTH AND WELLNESS SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-01",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-996-1677",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4515124",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.