Provider Demographics
NPI:1578683835
Name:EXCEL TUTORING AND PERSONAL DEVELOPMENT
Entity Type:Organization
Organization Name:EXCEL TUTORING AND PERSONAL DEVELOPMENT
Other - Org Name:EXCEL PERSONAL DEVLOPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-510-1535
Mailing Address - Street 1:8520 CLIFF CAMERON DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0012
Mailing Address - Country:US
Mailing Address - Phone:704-510-1535
Mailing Address - Fax:704-940-8060
Practice Address - Street 1:1385 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5127
Practice Address - Country:US
Practice Address - Phone:704-854-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005276Medicaid