Provider Demographics
NPI:1225623499
Name:EXCELLENCE, EDEM MATTHIAS (MS, LCSW-A)
Entity Type:Individual
Prefix:MR
First Name:EDEM
Middle Name:MATTHIAS
Last Name:EXCELLENCE
Suffix:
Gender:M
Credentials:MS, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3500 WESTGATE DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2567
Mailing Address - Country:US
Mailing Address - Phone:910-367-4161
Mailing Address - Fax:919-493-5026
Practice Address - Street 1:3500 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2567
Practice Address - Country:US
Practice Address - Phone:910-367-4161
Practice Address - Fax:919-493-5026
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0158971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty