Black Serene, PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

BLACK SERENE, PLLC

Practice address

3350 Footbridge LN
Ste 124 #524
Fayetteville, NC 28306-9695

Phone

(404) 649-5274

NPI assigned

May 9, 2024

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.

• Dazzmen Nikole Davis, LCMHC, LPC

  • Professional Counselor
  • Fayetteville, NC
  • NPI 1184279002
  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": "1778025600000",
    "number": "1184472573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 FOOTBRIDGE LN STE 124",
            "address_2": "#524",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283069695",
            "telephone_number": "980-990-2642",
            "fax_number": "404-726-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 FOOTBRIDGE LN",
            "address_2": "STE 124 #524",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283069695",
            "telephone_number": "404-649-5274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK SERENE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-09",
        "last_updated": "2026-05-06",
        "certification_date": "2026-05-06",
        "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": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Bishop
• Hubert Piotr Bitner, MD
• Autumn Bixler, PA-C
• Lisa Marie Bixler
• BJ'S Wholesale Club Inc.
• Ashley Black, PA
• Barbara Black, M.S., LCAS
• Catarrus Black
• Chelsea Gebs Black, PA-C
• Kelly Black, OTR/L

• Professional Counselor in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.