Domonique Blackmon, M.S., LPCA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A11622 Issued in NC

Practice address

1708 Trawick Rd
Suite 101
Raleigh, NC 27604-3897

Phone

(919) 896-7536

Fax

(919) 896-7537

NPI assigned

Jun 6, 2015

Sex

Female

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  NC, Professional

  Medicare reassignment NPD
• Marvin Behavioral Health Ma PC

  • Psychologist
  • Boston, MA
  • NPI 1740860428
  NPD (past)

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

{
    "created_epoch": "1433548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433548800000",
    "number": "1770963597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2816 VANSTORY ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274074844",
            "telephone_number": "757-214-2423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1708 TRAWICK RD",
            "address_2": "SUITE 101",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276043897",
            "telephone_number": "919-896-7536",
            "fax_number": "919-896-7537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "DOMONIQUE",
        "credential": "M.S., LPCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-06",
        "last_updated": "2015-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A11622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Winn Black, PA-C
• Tammy Blackard Cook, LCSW
• Jeffrey Robert Blackburn, MD
• Mallory Serpan Blackburn, OTR/L
• Marcia Michelle Blackmon Leveris, PHARMD
• Sebrena Blacknall, LPN
• Cole Blackwell, DC
• Danielle Blackwell, MS, LAT/ATC
• Erika Melissa Blackwell, CRNA
• Macy Blackwell, FNP

• Professional Counselor in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.