Provider Demographics
NPI:1174922348
Name:CENTER FOR EMOTIONAL HEALTH
Entity type:Organization
Organization Name:CENTER FOR EMOTIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:STOUDMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-237-4240
Mailing Address - Street 1:280 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1838
Mailing Address - Country:US
Mailing Address - Phone:704-237-4240
Mailing Address - Fax:704-841-3889
Practice Address - Street 1:640 SUMMIT CROSS PLACE
Practice Address - Street 2:SUITE 203
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-237-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005008272084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900927Medicaid