Provider Demographics
NPI:1851137558
Name:ESSENTIALS OF EXCELLENCE ACADEMY
Entity type:Organization
Organization Name:ESSENTIALS OF EXCELLENCE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:586-945-6048
Mailing Address - Street 1:15700 W 10 MILE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2100
Mailing Address - Country:US
Mailing Address - Phone:947-900-4533
Mailing Address - Fax:
Practice Address - Street 1:15700 W 10 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2100
Practice Address - Country:US
Practice Address - Phone:947-900-4533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A & T PRIVATE CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency