Individual
DOMONIQUE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., LPCA
Contact information
Practice address
1708 TRAWICK RD, SUITE 101, RALEIGH, NC 27604-3897
(919) 896-7536
(919) 896-7537
Mailing address
2816 VANSTORY ST, GREENSBORO, NC 27407-4844
(757) 214-2423
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
A11622
NC
Other
Enumeration date
06/06/2015
Last updated
06/06/2015
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