MEDICARE: EXCEL PSYCHIATRIC ASSOCIATES, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C007832	NC
2	2084P0800X	Psychiatry Physician	2009-00088	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306183546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL PSYCHIATRIC ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	10225 HICKORYWOOD HILL AVE
Second Line	:	SUITE B
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3431
Country	:	US
Telephone Number	:	704-457-9292
Fax Number	:	704-274-5783

Provider Business Practice Location Address
First Line	:	10225 HICKORYWOOD HILL AVE
Second Line	:	SUITE B
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-3431
Country	:	US
Telephone Number	:	704-457-9292
Fax Number	:	704-274-5783

Authorized Official
Title or Position	:	CO-OWNER
Name	:	TIFFANY CHRISTINE CHEPKE
Credential	:	LCSW
Telephone Number	:	704-457-9292

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	05/11/2017

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Directions to “EXCEL PSYCHIATRIC ASSOCIATES, PA ” Practice Location

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