Provider Demographics
NPI:1700278165
Name:CONNECTED PRO, LLC
Entity Type:Organization
Organization Name:CONNECTED PRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAMETRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:803-336-1089
Mailing Address - Street 1:3160 HWY 21
Mailing Address - Street 2:SUITE 103 #19
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715
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:803-336-1089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5370101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5370OtherLICENSED PROFESSIONAL COUNSELOR
VA0701007567OtherLICENSED PROFESSIONAL COUNSELOR
NC6115105Medicaid
NC8855OtherLICENSED PROFESSIONAL COUNSELOR
MI6401016479OtherLICENSED PROFESSIONAL COUNSELOR
OHC.1801012OtherLICENSED PROFESSIONAL COUNSELOR
GALPC010060OtherLICENSED PROFESSIONAL COUNSELOR
SCPC1370Medicaid