# ALTAVERA BEHAVIORAL HEALTH PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174465702
- **Authorized official:** JONATHAN KEITH STOUDMIRE SR. MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (704) 699-5296

## Contact information

- **Practice address:** 432 COPPERFIELD BLVD NE STE 200, CONCORD, NC 28025-2427
- **Practice address phone:** (704) 906-9573
- **Mailing address:** 432 COPPERFIELD BLVD NE STE 200, CONCORD, NC 28025-2427
- **Mailing address phone:** (704) 906-9573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0802X | Addiction Psychiatry Physician | — | NULL | Yes |
| 2084P0802X | Addiction Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/06/2026
- **Last updated:** 04/06/2026