Provider Demographics
NPI:1447370051
Name:EXCEL PERSONAL DEVELOPMENT
Entity type:Organization
Organization Name:EXCEL PERSONAL DEVELOPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1201 S POST RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-7438
Practice Address - Country:US
Practice Address - Phone:704-481-1129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301807Medicaid