Provider Demographics
NPI:1396990255
Name:THE EXCELLENCE EDGE INC.
Entity type:Organization
Organization Name:THE EXCELLENCE EDGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LIN
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:SHANER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-772-0730
Mailing Address - Street 1:3433 BRAMBLETON AVE STE 205B
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6527
Mailing Address - Country:US
Mailing Address - Phone:540-772-0730
Mailing Address - Fax:540-772-4887
Practice Address - Street 1:3433 BRAMBLETON AVE STE 205B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6527
Practice Address - Country:US
Practice Address - Phone:540-772-0730
Practice Address - Fax:540-772-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty