Healthcare Provider Details

I. General information

NPI: 1265617062
Provider Name (Legal Business Name): EXCEL TUTORING AND PERSONAL DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 S MAIN ST
LEXINGTON NC
27292-3618
US

IV. Provider business mailing address

8520 CLIFF CAMERON DR SUITE 460
CHARLOTTE NC
28269-0012
US

V. Phone/Fax

Practice location:
  • Phone: 336-224-6861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN TILLMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 704-510-1535