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General NPI Number Information
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NPI Number | 1649247750
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Entity Type | Organization
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Legal Business Name | MARTIAL ART ACADEMY
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1302 WHISKEY RD
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City | AIKEN
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State | SC
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Zip | 29803-5308
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Country | US
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Telephone | 803-642-5723
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Fax | 803-642-1158
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Provider Business Mailing Address
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Address Line | 1302 WHISKEY RD
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City | AIKEN
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State | SC
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Zip | 29803-5308
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Country | US
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Telephone | 803-642-5723
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Fax | 803-642-1158
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. ANDREW LEROY BLOCKER
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Credential |
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Telephone | 803-642-5723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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