Organization
BLACK SERENE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAZZMEN NIKOLE DAVIS LCMHC, LPC (PRACTICE OWNER/LICENSED COUNSELOR)
(404) 649-5274
Entity
Organization
Contact information
Practice address
3350 FOOTBRIDGE LN, STE 124 #524, FAYETTEVILLE, NC 28306-9695
(404) 649-5274
Mailing address
3350 FOOTBRIDGE LN STE 124, #524, FAYETTEVILLE, NC 28306-9695
(980) 990-2642
(404) 726-4881
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
251B00000X
Case Management Agency
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
05/09/2024
Last updated
05/06/2026
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