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General NPI Number Information
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NPI Number | 1386564300
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Entity Type | Organization
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Legal Business Name | SACRED PATH PSYCHIATRY
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 301 S MCDOWELL ST STE 125-2060
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City | CHARLOTTE
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State | NC
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Zip | 28204-2623
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Country | US
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Telephone | 803-417-6325
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Fax |
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Provider Business Mailing Address
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Address Line | 1723 VALKRIE PL
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City | YORK
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State | SC
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Zip | 29745-6625
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Country | US
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Telephone | 803-417-6325
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KENDRA BLACKWELL
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Credential |
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Telephone | 803-417-6325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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