Healthcare Provider Details

I. General information

NPI: 1790609873
Provider Name (Legal Business Name): JALEIGHSA A BLAKENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N TRYON ST STE 1600
CHARLOTTE NC
28202-0213
US

IV. Provider business mailing address

1106 BROOKSLAND PL
WAXHAW NC
28173-0265
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 704-635-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: