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General NPI Number Information
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NPI Number | 1174922348
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Entity Type | Organization
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Legal Business Name | CENTER FOR EMOTIONAL HEALTH
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 640 SUMMIT CROSS PLACE SUITE 203
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City | GASTONIA
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State | NC
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Zip | 28054
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Country | US
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Telephone | 704-237-4240
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Fax |
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Provider Business Mailing Address
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Address Line | 280 EXECUTIVE PARK DR STE 100
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City | CONCORD
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State | NC
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Zip | 28025-1838
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Country | US
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Telephone | 704-237-4240
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Fax | 704-841-3889
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JONATHAN K STOUDMIRE
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Credential | M.D.
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Telephone | 704-237-4240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 200500827
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License Number State | NC
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