MEDICARE: AHMAD BLAKENEY LCAS-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS27033	NC
2	101YM0800X	Mental Health Counselor	A22132	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCAS27033	OTHER	NC	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275108599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHMAD BLAKENEY LCAS-A

Provider Business Mailing Address
First Line	:	4401 E INDEPENDENCE BLVD STE 208-G
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7485
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 E INDEPENDENCE BLVD STE 208-G
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7485
Country	:	US
Telephone Number	:	704-208-8038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	10/08/2025

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