Healthcare Provider Details

I. General information

NPI: 1851137558
Provider Name (Legal Business Name): ESSENTIALS OF EXCELLENCE ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 W 10 MILE RD STE 101
SOUTHFIELD MI
48075-2100
US

IV. Provider business mailing address

15700 W 10 MILE RD STE 101
SOUTHFIELD MI
48075-2100
US

V. Phone/Fax

Practice location:
  • Phone: 947-900-4533
  • Fax:
Mailing address:
  • Phone: 947-900-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BEVERLY RENE MANLEY
Title or Position: DIRECTOR
Credential: PHD
Phone: 586-945-6048