NPIMap

Organization Active NPI

Shumate Management LLC

Doing business as Blackwater Counseling and Wellness

  • Professional Counselor
  • Lynchburg, VA
National Provider Identifier
1487489134
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
SHUMATE MANAGEMENT LLC
Doing business as
Blackwater Counseling and Wellness
Practice address
2900 Old Forest Rd Ste a
Lynchburg, VA 24501-2335
Phone
(206) 235-0968
NPI assigned
Sep 3, 2024
Last updated
Nov 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Holly Shumate
Title
Owner
Phone
(206) 235-0968

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

2900 Old Forest Rd Ste a
Lynchburg, VA 24501-2335

Mailing address

2900 Old Forest Rd Ste a
Lynchburg, VA 24501-2335
Phone (434) 316-1826

Other names 1

  • Blackwater Counseling and Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250327003663 VA Part B Supplier - Clinic/Group Practice 1557884715 Receives reassigned benefits from 9 practitioners
Practice locations: Lynchburg, VA

National Provider Directory

National Provider Directory

Locations

2900 Old Forest Rd
Ste A
Lynchburg, VA 24501
Phone (434) 316-1826

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1487489134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 OLD FOREST RD STE A",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245012335",
            "telephone_number": "434-316-1826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 OLD FOREST RD STE A",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245012335",
            "telephone_number": "206-235-0968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHUMATE MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-03",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "SHUMATE",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-235-0968"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackwater Counseling and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynchburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.