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Organization
SPORTSSMARTS
Active
Organization
SPORTSSMARTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AHMAD BLAKENEY (CEO)
(704) 248-0514
Entity
Organization
Contact information
Practice address
4401 E INDEPENDENCE BLVD, SUITE 201B, CHARLOTTE, NC 28205-7485
(704) 248-0514
Mailing address
4401 E INDEPENDENCE BLVD, SUITE 201B, CHARLOTTE, NC 28205-7485
(704) 248-0514
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
103TE1100X
Exercise & Sports Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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