Provider Demographics
NPI:1760501597
Name:EXCEL TUTORING AND PERSONAL DEVELOPMENT
Entity Type:Organization
Organization Name:EXCEL TUTORING AND PERSONAL DEVELOPMENT
Other - Org Name:EXCEL PERSONAL DEVELOPMENT
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:704-635-7766
Mailing Address - Street 1:1502 N CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2500
Mailing Address - Country:US
Mailing Address - Phone:704-635-7766
Mailing Address - Fax:704-635-7779
Practice Address - Street 1:5416 RAEFORD RD STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3157
Practice Address - Country:US
Practice Address - Phone:910-223-7775
Practice Address - Fax:910-223-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300847Medicaid