Provider Demographics
NPI:1023858859
Name:BLEVINS, WILLIAM CHARLES
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 S SHARON AMITY RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2850
Mailing Address - Country:US
Mailing Address - Phone:704-264-2973
Mailing Address - Fax:980-498-6700
Practice Address - Street 1:447 S SHARON AMITY RD STE 260
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2836
Practice Address - Country:US
Practice Address - Phone:704-264-2973
Practice Address - Fax:980-498-6700
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist