Black Serene, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

BLACK SERENE, PLLC

Practice address

10130 Mallard Creek Rd Ste 300
Charlotte, NC 28262-6001

Phone

(404) 649-5274

Fax

(404) 726-4881

NPI assigned

May 9, 2024

Last updated

Oct 20, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dazzmen Nikole Davis, LCMHC, LPCNPI 1184279002

Title

Practice Owner/Licensed Counselor

Phone

(404) 649-5274

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dazzmen Nikole Davis, LCMHC, LPC

  • Professional Counselor
  • Charlotte, NC
  • NPI 1184279002

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1715212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792454400000",
    "number": "1184472573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10130 MALLARD CREEK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626001",
            "telephone_number": "404-649-5274",
            "fax_number": "404-726-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10130 MALLARD CREEK RD STE 300",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282626001",
            "telephone_number": "404-649-5274",
            "fax_number": "404-726-4881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK SERENE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-09",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "DAZZMEN",
        "authorized_official_middle_name": "NIKOLE",
        "authorized_official_title_or_position": "PRACTICE OWNER/LICENSED COUNSELOR",
        "authorized_official_telephone_number": "404-649-5274",
        "authorized_official_credential": "LCMHC, LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2026; 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.