Individual
JORDAN BLAKENEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1036 ASSEMBLY DR, FORT MILL, SC 29708-6400
(980) 250-2438
Mailing address
1906 MEREVIEW CT UNIT 9, CHARLOTTE, NC 28210-7496
(704) 957-4971
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8745
SC
106S00000X
Behavior Technician
—
—
Other
Enumeration date
06/29/2022
Last updated
11/14/2023
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