Organization
EVOLUTIONARY INTERVENTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON C JACKSON (OWNER)
(888) 492-9386
Entity
Organization
Contact information
Practice address
17348 W 12 MILE RD, SUITE 106, SOUTHFIELD, MI 48076-2120
(888) 492-9386
(888) 492-9386
Mailing address
PO BOX 760224, LATHRUP VILLAGE, MI 48076-0224
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
02/23/2012
Last updated
05/20/2021
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