Organization
BLACK EXCELLENCE PSYCHOTHERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FITZGERALD AJOKU (FOUNDER)
(914) 609-1183
Entity
Organization
Contact information
Practice address
30047 N WAUKEGAN RD, LAKE BLUFF, IL 60044-1023
(718) 342-4986
Mailing address
30047 N WAUKEGAN RD, LAKE BLUFF, IL 60044-1023
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
01/31/2022
Last updated
10/16/2022
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