| Black Excellence Psychotherapy Pllc | |
|
30047 N Waukegan Rd Lake Bluff IL 60044-1023 | |
| (718) 342-4986 | |
| Not Available |
| Full Name | Black Excellence Psychotherapy Pllc |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 30047 N Waukegan Rd, Lake Bluff, Illinois |
| Authorized Official Name and Position | Fitzgerald Ajoku (FOUNDER) |
| Authorized Official Contact | 9146091183 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Excellence Psychotherapy Pllc 30047 N Waukegan Rd Lake Bluff IL 60044-1023 Ph: () - | Black Excellence Psychotherapy Pllc 30047 N Waukegan Rd Lake Bluff IL 60044-1023 Ph: (718) 342-4986 |
| NPI Number | 1700539681 |
|---|---|
| Provider Enumeration Date | 01/31/2022 |
| Last Update Date | 10/16/2022 |
| Certification Date | 10/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700539681 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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