Healthcare Provider Details

I. General information

NPI: 1528720497
Provider Name (Legal Business Name): CHARLES MONTJOY LMCHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 JUDGES RD STE 4E
WILMINGTON NC
28405-3655
US

IV. Provider business mailing address

311 JUDGES RD STE 4E
WILMINGTON NC
28405-3655
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-6767
  • Fax: 910-399-2190
Mailing address:
  • Phone: 910-791-6767
  • Fax: 910-399-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17047
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17047
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: