Carmen Shanise Blackmon, MA, NCC, LCMHC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A8739 Issued in NC

Practice address

339 Esther Cir
Kannapolis, NC 28083-9026

Phone

(704) 224-3260

NPI assigned

Apr 19, 2011

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

Practice roles

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

• Shanise Blackmon Inc

  • Community/Behavioral Health Agency
  • Kannapolis, NC
  • NPI 1538960240
  NPD Authorized official

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1831489210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 ESTHER CIR",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280839026",
            "telephone_number": "704-298-8926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 ESTHER CIR",
            "city": "KANNAPOLIS",
            "state": "NC",
            "postal_code": "280839026",
            "telephone_number": "704-224-3260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKMON",
        "first_name": "CARMEN",
        "middle_name": "SHANISE",
        "name_prefix": "Miss",
        "credential": "MA, NCC, LCMHC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-19",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A8739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beverly Broadwell DDS PLLC
• Beverly Joyce Lessane MD Internal Medicine PLLC
• Arpit Pankaj Bhatt, PHARM D
• Bhavana Jayaram LLC
• Kerry R. Bianchi, MD
• Patricia Ann Blakely
• Tamberlyn Kathleen Blinsink, N.D.
• Sarah Elizabeth Bluma
• Evie Boatwright, OTR/L
• Sonja Jo Bohannon-Thacker, MSW, LCSW

• Professional Counselor in Kannapolis, NC
• Providers in Kannapolis, 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 Mar 20, 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.

Verify at the official NPI Registry.