Kimberly Anne Blackmon, LPC, NCC, LCAS, CCS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

398 Issued in NC

Practice address

429 Billingsley Rd
Mecklenburg County Amh Sasc
Charlotte, NC 28211-1007

Phone

(704) 336-5651

Fax

(704) 336-5105

NPI assigned

Mar 14, 2007

Last updated

Oct 22, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Kimberly Anne Phillips Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413936000000",
    "number": "1083747224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12631 BULLOCK GREENWAY BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282778177",
            "telephone_number": "980-245-8433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 BILLINGSLEY RD",
            "address_2": "MECKLENBURG COUNTY AMH SASC",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111007",
            "telephone_number": "704-336-5651",
            "fax_number": "704-336-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "credential": "LPC, NCC, LCAS, CCS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-14",
        "last_updated": "2014-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "398",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "3706S",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6102838",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "PHILLIPS",
            "middle_name": "ANNE",
            "credential": "LPCS, LCAS, CCS, NCC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephanie Anne Blackburn, LCSW
• Donald Wayne Blackley, M.D.
• Aaron T Blackmer, P.A
• Alicia Blackmon
• Ebony Lasha Blackmon
• Lindsay Lowery Blackmon, MSW, LCSW, LCAS
• Pamela Stuckey Blackmon, C.S.A.C.
• Reginald Blackmon Sr.
• Zondra Blackmon, LMBT
• Karen H Blackwelder, PA-C

• Addiction (Substance Use Disorder) Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.