Organization
EVOLVE LIFE CENTERS IOP LLC
Active
Parent organization
EVOLVE LIFE CENTERS IOP LLC
Other names
ELC Mental Health Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVOLVE LIFE CENTERS IOP LLC
Authorized official
JESSIE COSTLEY (CREDENTIALING SPECIALIST)
(443) 548-3733
Entity
Organization
Contact information
Practice address
2528 MOUNTAIN RD STE 102-204, PASADENA, MD 21122-7203
(443) 548-3733
(410) 360-1675
Mailing address
2528 MOUNTAIN RD STE 204, PASADENA, MD 21122-7204
(443) 548-3733
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200468200
—
MD
Enumeration date
01/07/2022
Last updated
03/24/2023
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