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General NPI Number Information
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NPI Number | 1295602910
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Entity Type | Organization
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Legal Business Name | EXODUS NEW BEGINNINGS, LLC
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 4641 OLD MONROE RD
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5311
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Country | US
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Telephone | 704-635-3875
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Fax |
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Provider Business Mailing Address
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Address Line | 4024 EUTAW DR
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City | WAXHAW
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State | NC
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Zip | 28173-8936
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Country | US
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Telephone | 704-296-7419
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ADRIENE LEE COVINGTON
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Credential |
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Telephone | 704-296-7419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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