MEDICARE: BETHESDA COUNSELING SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2562	NC

General Provider Information

NPI Number	:	1528245354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	13850 BALLANTYNE CORPORATE PL
Second Line	:	SUITE 500
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2829
Country	:	US
Telephone Number	:	704-887-5259
Fax Number	:	704-887-5201

Provider Business Practice Location Address
First Line	:	13850 BALLANTYNE CORPORATE PL
Second Line	:	SUITE 500
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-2829
Country	:	US
Telephone Number	:	704-887-5259
Fax Number	:	704-887-5201

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/THERAPIST
Name	:	JEFFREY A LANGDON
Credential	:	LPA
Telephone Number	:	704-887-5259

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/23/2008

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