Healthcare Provider Details

I. General information

NPI: 1568918613
Provider Name (Legal Business Name): BELLAMENTE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5970 FAIRVIEW RD
CHARLOTTE NC
28210-3167
US

IV. Provider business mailing address

5970 FAIRVIEW RD
CHARLOTTE NC
28210-3167
US

V. Phone/Fax

Practice location:
  • Phone: 704-362-5355
  • Fax:
Mailing address:
  • Phone: 704-362-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4982
License Number StateNC

VIII. Authorized Official

Name: DR. MICHELLE CONSTANTINO
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 330-301-3343