Active NPI
Bradley Blackburn, LCMHC, NCC
- Mental Health Counselor
- Concord, NC
National Provider Identifier
1649947912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 16749
- Practice address
- 23 Union St N Ste a
Concord, NC 28025-4726 - Phone
- (704) 918-5584
- Fax
- (833) 552-2077
- NPI assigned
- Aug 25, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 16749 | NC | |
| Mental Health Counselor | 101YM0800X | 16749 | NC | Primary |
Addresses
Primary practice location
23 Union St N Ste a
Concord, NC 28025-4726
Mailing address
PO Box 1792
Concord, NC 28026-1792
Phone (704) 918-5584
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16749 | NC | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629849600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750118400000",
"number": "1649947912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1792",
"city": "CONCORD",
"state": "NC",
"postal_code": "280261792",
"telephone_number": "704-918-5584",
"fax_number": "833-552-2077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 UNION ST N STE A",
"city": "CONCORD",
"state": "NC",
"postal_code": "280254726",
"telephone_number": "704-918-5584",
"fax_number": "833-552-2077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACKBURN",
"first_name": "BRADLEY",
"name_prefix": "Mr.",
"credential": "LCMHC, NCC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-08-25",
"last_updated": "2025-06-17",
"certification_date": "2025-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "16749",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "16749",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.