Organization
EVOLUTION THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY VALERIE FERGUSON (MANAGER)
(240) 899-3473
Entity
Organization
Contact information
Practice address
15401 WYLIE RD, BRANDYWINE, MD 20613-6216
(202) 374-0609
(301) 808-6562
Mailing address
15401 WYLIE RD, BRANDYWINE, MD 20613-6216
(202) 374-0609
(301) 808-6562
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
07/11/2022
Last updated
07/11/2022
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