Healthcare Provider Details

I. General information

NPI: 1609481704
Provider Name (Legal Business Name): BELMONT PSYCHIATRY & COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16930 W CATAWBA AVE STE 200
CORNELIUS NC
28031-5639
US

IV. Provider business mailing address

210 N CHURCH ST UNIT 1309
CHARLOTTE NC
28202-2266
US

V. Phone/Fax

Practice location:
  • Phone: 704-322-4020
  • Fax: 704-282-3018
Mailing address:
  • Phone: 704-430-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. PHIL ORB JOHNS JR.
Title or Position: OWNER/EMPLOYEE
Credential: PA-C
Phone: 704-430-6268