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General NPI Number Information
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NPI Number | 1750196747
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Entity Type | Organization
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Legal Business Name | LADY OF EXCELLENCE LLC
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Dates
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Enumeration Date | 02/08/2025
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Last Update Date | 02/08/2025
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Provider Practice Location Address
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Address Line | 82 SAINT MARKS PL APT 3I
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City | STATEN ISLAND
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State | NY
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Zip | 10301-1646
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Country | US
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Telephone | 254-383-8718
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Fax |
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Provider Business Mailing Address
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Address Line | 5525 STUBBEN CT
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City | COLUMBUS
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State | GA
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Zip | 31909-1871
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Country | US
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Telephone | 254-383-8718
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | SHARMAIN BURCH
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Credential |
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Telephone | 254-383-8718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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