Provider Demographics
NPI:1083420137
Name:FAVOR ACADEMY OF EXCELLENCE, INC.
Entity type:Organization
Organization Name:FAVOR ACADEMY OF EXCELLENCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:770-820-4159
Mailing Address - Street 1:3305 LAKE VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8157
Mailing Address - Country:US
Mailing Address - Phone:770-820-4159
Mailing Address - Fax:
Practice Address - Street 1:8641 DORRIS RD STE 230B
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-7507
Practice Address - Country:US
Practice Address - Phone:770-693-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health