Provider Demographics
NPI:1396407284
Name:SPORT DEVELOPMENT SERVICES INC.
Entity Type:Organization
Organization Name:SPORT DEVELOPMENT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/EXECUTIVE DIRECTOR/MENTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:ASHTON
Authorized Official - Last Name:WILLIAMS-AGNEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-244-0894
Mailing Address - Street 1:19 BOYDEN ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 BOYDEN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-3212
Practice Address - Country:US
Practice Address - Phone:781-244-0894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty