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Organization
EVOLUTION OF SELF
Active
Organization
EVOLUTION OF SELF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE SHAMBERGER (OWNER)
(336) 618-7697
Entity
Organization
Contact information
Practice address
701 GREEN VALLEY RD STE 100, ROOM 330, GREENSBORO, NC 27408-7096
(336) 618-7697
Mailing address
701 GREEN VALLEY RD STE 100, #330, GREENSBORO, NC 27408-7096
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/01/2025
Last updated
11/19/2025
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