Organization
THE EVOLUTION GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL BLACKWOOD LPCC (DIRECTOR)
(505) 242-6988
Entity
Organization
Contact information
Practice address
218 BROADWAY BLVD SE, ALBUQUERQUE, NM 87102-3425
(505) 242-6988
(505) 242-6972
Mailing address
218 BROADWAY BLVD SE, ALBUQUERQUE, NM 87102-3425
(505) 242-6988
(505) 242-6972
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87423251
—
NM
Enumeration date
05/09/2008
Last updated
12/10/2018
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