Jacob Stephen Blackstock, LCMHCA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A13081 Issued in NC

Practice address

231 N Spring St
Greensboro, NC 27401-2231

Phone

(336) 899-8800

NPI assigned

Jan 21, 2021

Last updated

Jan 21, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 29, 2025 through Jan 29, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Family Solutions, PLLC

  • Community/Behavioral Health Agency
  • Greensboro, NC
  • NPI 1285921064
  NPD

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1740870997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3026 STRATFORD DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274082625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 N SPRING ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274012231",
            "telephone_number": "336-899-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSTOCK",
        "first_name": "JACOB",
        "middle_name": "STEPHEN",
        "credential": "LCMHCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A13081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Yates Blackman, MD
• Douglas A Blackman, MD
• Loneke Blackman, RD
• Rebecca Kim Blackman
• Erin Blackmon, OTR/L
• Blackwell House Inc.
• Tommy Alan Blackwell, D.D.S.
• Blair Kahzan Center
• Wendy Sanders Blair, PA-C
• Brittany Ann Blake, PHARMD

• Mental Health Counselor in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.

Verify at the official NPI Registry.