Provider Demographics
NPI:1902665771
Name:BLACK EXCELLENCE STRIVING THERAPEUTIC
Entity Type:Organization
Organization Name:BLACK EXCELLENCE STRIVING THERAPEUTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALIFIED PROFESSIONAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:DEONTOINE
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS
Authorized Official - Phone:919-879-6090
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-0771
Mailing Address - Country:US
Mailing Address - Phone:919-879-6090
Mailing Address - Fax:
Practice Address - Street 1:142 SOUTHERN PLAZA DR
Practice Address - Street 2:
Practice Address - City:DUDLEY
Practice Address - State:NC
Practice Address - Zip Code:28333-9159
Practice Address - Country:US
Practice Address - Phone:919-879-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children