Individual provider Active NPI

Shacoya Graham, MA, LMFT, LCAS-A

  • Marriage & Family Therapist
  • Charlotte, NC
National Provider Identifier
1265021729
Registry record updated Sep 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
2527 Issued in NC
Practice address
2515 Anna Garrison Rd
Charlotte, NC 28206-1767
Phone
(843) 465-2486
NPI assigned
Jan 11, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X 2527 NC Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X LCAS-26532 NC

Addresses

Primary practice location

2515 Anna Garrison Rd
Charlotte, NC 28206-1767

Mailing address

9541 Julian Clark Ave Ste 208
Huntersville, NC 28078-3486
Phone (843) 465-2486

Other practice location 1

13420 Reese Blvd W
Huntersville, NC 28078-7925
Phone (843) 465-2486

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260403001727 NC Practitioner - Marriage and Family Therapist 6507347788 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Blossom Family Therapy PLLCGroup PAC ID 4880175066, 3 clinicians

Practice addresses (Care Compare)

13420 Reese Blvd W
Huntersville, NC 28078-7925
Phone (980) 297-8237

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
LCAS-26532NCMDAddiction (Substance Use Disorder) Counselor
2527NCMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Blossom Family Therapy PLLC Multi-Specialty CurrentSince Dec 15, 2025 Accepting new patients

Locations

13420 Reese Blvd W
Huntersville, NC 28078
Phone (704) 433-6644

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758499200000",
    "number": "1265021729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9541 JULIAN CLARK AVE STE 208",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280783486",
            "telephone_number": "843-465-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 ANNA GARRISON RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282061767",
            "telephone_number": "843-465-2486"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13420 REESE BLVD W",
            "address_purpose": "LOCATION",
            "city": "HUNTERSVILLE",
            "state": "NC",
            "postal_code": "280787925",
            "country_code": "US",
            "telephone_number": "843-465-2486",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "SHACOYA",
        "credential": "MA, LMFT, LCAS-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-11",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "NC",
            "license": "2527",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-26532",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.