Active NPI
Blake Hamilton Clemmons, LPCA
- Professional Counselor
- Charlotte, NC
National Provider Identifier
1427417641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- A12043
- Practice address
- 2124 Crown Centre Dr
Suite 400
Charlotte, NC 28227-7803 - Phone
- (704) 849-0144
- NPI assigned
- Feb 16, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | A12043 | NC | Primary |
Addresses
Primary practice location
2124 Crown Centre Dr
Suite 400
Charlotte, NC 28227-7803
Mailing address
2124 Crown Centre Dr
Suite 400
Charlotte, NC 28227-7803
Phone (704) 849-0144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 22, 2024 through Mar 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A12043 | NC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455580800000",
"number": "1427417641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2124 CROWN CENTRE DR",
"address_2": "SUITE 400",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282277803",
"telephone_number": "704-849-0144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2124 CROWN CENTRE DR",
"address_2": "SUITE 400",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282277803",
"telephone_number": "704-849-0144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEMMONS",
"first_name": "BLAKE",
"middle_name": "HAMILTON",
"name_prefix": "Mr.",
"credential": "LPCA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-02-16",
"last_updated": "2016-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "A12043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.