Evolution of Self

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

EVOLUTION OF SELF

Practice address

701 Green Valley Rd Ste 100
Room 330
Greensboro, NC 27408-7096

Phone

(336) 618-7697

NPI assigned

May 1, 2025

Last updated

Nov 19, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dominique ShambergerNPI 1538704077

Title

Owner

Phone

(336) 618-7697

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dominique Shamberger, LCSW

  • Clinical Social Worker
  • Danville, VA
  • NPI 1538704077

  NC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1746057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763510400000",
    "number": "1255120978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 GREEN VALLEY RD STE 100",
            "address_2": "#330",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GREEN VALLEY RD STE 100",
            "address_2": "ROOM 330",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274087096",
            "telephone_number": "336-618-7697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTION OF SELF",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-01",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A",
        "authorized_official_last_name": "SHAMBERGER",
        "authorized_official_first_name": "DOMINIQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-618-7697"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.