Provider Demographics
NPI:1609481704
Name:BELMONT PSYCHIATRY & COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:BELMONT PSYCHIATRY & COUNSELING SERVICES PLLC
Other - Org Name:SERENITY PSYCHIATRIC & COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:ORB
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:704-430-6268
Mailing Address - Street 1:210 N CHURCH ST UNIT 1309
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2266
Mailing Address - Country:US
Mailing Address - Phone:704-430-6268
Mailing Address - Fax:
Practice Address - Street 1:16930 W CATAWBA AVE STE 200
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5639
Practice Address - Country:US
Practice Address - Phone:704-322-4020
Practice Address - Fax:704-282-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty