MEDICARE: HEALTHY MINDS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	253Z00000X	In Home Supportive Care Agency
3	101YM0800X	Mental Health Counselor
4	163WP0808X	Psychiatric/Mental Health Registered Nurse
5	251S00000X	Community/Behavioral Health Agency
6	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1649869207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY MINDS LLC

Provider Business Mailing Address
First Line	:	4401 E INDEPENDENCE BLVD STE 208G
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7485
Country	:	US
Telephone Number	:	704-201-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 E INDEPENDENCE BLVD STE 208G
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7485
Country	:	US
Telephone Number	:	704-201-8038
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AHMAD BLAKENEY
Credential	:
Telephone Number	:	704-201-8038

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	08/07/2025

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