Evolution Therapeutic Services
Organization Active NPI Social Worker · Brandywine, MD
NPI 1457085904 · NPPES record last updated Jul 11, 2022
Key facts
- NPI
- 1457085904
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Social Worker 104100000X
- Legal business name
- EVOLUTION THERAPEUTIC SERVICES
- Practice address
- 15401 Wylie Rd
Brandywine, MD 20613-6216 - Phone
- (202) 374-0609
- Fax
- (301) 808-6562
- NPI assigned
- Jul 11, 2022
- Organization subpart
- No
Authorized official
- Name
- Stacey Valerie Ferguson
- Title
- Manager
- Phone
- (240) 899-3473
Practitioners 2
-
Stefanie Colisa Lea, LMSW
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker |
104100000X | Yes |
Addresses
Primary practice location
15401 Wylie Rd
Brandywine, MD 20613-6216
Mailing address
15401 Wylie Rd
Brandywine, MD 20613-6216
Phone (202) 374-0609
Other providers in Brandywine, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.