| Excellence Noire Llc | |
|
100 Carrington Park Apt 2104 Jonesboro GA 30236-2888 | |
| (607) 346-1321 | |
| Not Available |
| Full Name | Excellence Noire Llc |
|---|---|
| Speciality | Behavior Technician |
| Location | 100 Carrington Park Apt 2104, Jonesboro, Georgia |
| Authorized Official Name and Position | Darius Cooper (CEO) |
| Authorized Official Contact | 6073451321 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Excellence Noire Llc 100 Carrington Park Apt 2104 Jonesboro GA 30236-2888 Ph: (607) 346-1321 | Excellence Noire Llc 100 Carrington Park Apt 2104 Jonesboro GA 30236-2888 Ph: (607) 346-1321 |
| NPI Number | 1225728660 |
|---|---|
| Provider Enumeration Date | 05/09/2023 |
| Last Update Date | 05/09/2023 |
| Certification Date | 05/09/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225728660 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106S00000X | Behavior Technician | (* (Not Available)) | Primary |
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