Provider Demographics
NPI:1356533343
Name:EXCEL TUTORING AND PERSONAL DEVELOPMENT
Entity type:Organization
Organization Name:EXCEL TUTORING AND PERSONAL DEVELOPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
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 1:788 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-5032
Practice Address - Country:US
Practice Address - Phone:704-793-1126
Practice Address - Fax:704-793-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302144Medicaid