Individual
PAMELA STUCKEY BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.S.A.C.
Contact information
Practice address
5601 EXECUTIVE CENTER DR STE 101, CHARLOTTE, NC 28212-8841
(704) 561-0920
(704) 561-0851
Mailing address
12504 SUSANNA DR, CHARLOTTE, NC 28214-6490
(704) 562-9414
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1879
NC
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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