MEDICARE: BLAIR CLINICAL SERVICES PLLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1376377374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAIR CLINICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	8045 CORPORATE CENTER DR STE 3011-I
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4555
Country	:	US
Telephone Number	:	980-351-4216
Fax Number	:	980-217-6527

Provider Business Practice Location Address
First Line	:	8045 CORPORATE CENTER DR STE 3011-I
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-4555
Country	:	US
Telephone Number	:	980-351-4216
Fax Number	:	980-217-6527

Authorized Official
Title or Position	:	OWNER
Name	:	BLAIR HARRINGTON
Credential	:	LCMHC
Telephone Number	:	980-351-4216

Provider Enumeration Date	:	08/30/2024
Last Update Date	:	08/30/2024

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