Provider Demographics
NPI:1225623499
Name:EXCELLENCE, EDEM MATTHIAS (MS, LCSW-A)
Entity type:Individual
Prefix:MR
First Name:EDEM
Middle Name:MATTHIAS
Last Name:EXCELLENCE
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Gender:M
Credentials:MS, LCSW-A
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Mailing Address - Street 1:11125 HAZEL GARDENS DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7942
Mailing Address - Country:US
Mailing Address - Phone:980-416-3025
Mailing Address - Fax:980-448-3419
Practice Address - Street 1:432 EAST LONG AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2540
Practice Address - Country:US
Practice Address - Phone:980-416-3025
Practice Address - Fax:980-448-3419
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2025-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NCP0158971041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)