Individual
KIMBERLY ANNE BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, NCC, LCAS, CCS
Contact information
Practice address
429 BILLINGSLEY RD, MECKLENBURG COUNTY AMH SASC, CHARLOTTE, NC 28211-1007
(704) 336-5651
(704) 336-5105
Mailing address
12631 BULLOCK GREENWAY BLVD, CHARLOTTE, NC 28277-8177
(980) 245-8433
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
398
NC
101YP2500X
Professional Counselor
3706S
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6102838
—
NC
Enumeration date
03/14/2007
Last updated
10/22/2014
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