Healthcare Provider Details

I. General information

NPI: 1619893997
Provider Name (Legal Business Name): BLAKES ENRICKMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 HONEYSUCKLE RD STE 22
DOTHAN AL
36305-1119
US

IV. Provider business mailing address

256 HONEYSUCKLE RD STE 22
DOTHAN AL
36305-1119
US

V. Phone/Fax

Practice location:
  • Phone: 334-784-0867
  • Fax:
Mailing address:
  • Phone: 334-784-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW HEARD
Title or Position: OWNER
Credential: LPC
Phone: 334-784-0867