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Contact Information

SPORTSSMARTS
4401 E INDEPENDENCE BLVD
SUITE 201B
CHARLOTTE, NC28205-7485
 Phone: 704-248-0514
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Professional

101YP2500X
 

Addiction (Substance Use Disorder)

101YA0400X
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Community/Behavioral Health

251S00000X
 

Exercise & Sports

103TE1100X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for SPORTSSMARTS

NPI # 1861778102
LBN Legal business name SPORTSSMARTS
Authorized official AHMAD BLAKENEY - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 11/01/2011
Last updated 11/01/2011 - About 15 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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