Provider Demographics
NPI:1356301873
Name:BELLIS, JOHN TIMOTHY JR (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TIMOTHY
Last Name:BELLIS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 TYREL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9501
Mailing Address - Country:US
Mailing Address - Phone:704-560-0515
Mailing Address - Fax:
Practice Address - Street 1:6227 TYREL DRIVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-9501
Practice Address - Country:US
Practice Address - Phone:704-560-0515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002733Medicaid
NC6002618Medicaid