Provider Demographics
NPI:1639455488
Name:BLOUNT, NAMETRIS (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:NAMETRIS
Middle Name:
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 HIGHWAY 21 STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8888
Mailing Address - Country:US
Mailing Address - Phone:803-336-1089
Mailing Address - Fax:
Practice Address - Street 1:118 ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715
Practice Address - Country:US
Practice Address - Phone:704-350-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010060101YP2500X
OHC.1801012101YP2500X
VA0701007567101YP2500X
NC8855101YP2500X
TX83566101YP2500X
MI6401016479101YP2500X
MS2288101YP2500X
SC5370101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1370Medicaid
MS2288OtherLICENSED PROFESSIONAL COUNSELOR
OHC.1801012OtherLICENSED PROFESSIONAL COUNSELOR
GALPC010060OtherLICENSED PROFESSIONAL COUNSELOR
VA0701007567OtherLICENSED PROFESSIONAL COUNSELOR
NC8855OtherLICENSED PROFESSIONAL COUNSELOR
SC5370OtherLICENSED PROFESSIONAL COUNSELOR
NC6115105Medicaid
MI6401016479OtherLICENSED PROFESSIONAL COUNSELOR