Provider Demographics
NPI:1538960240
Name:SHANISE BLACKMON INC
Entity type:Organization
Organization Name:SHANISE BLACKMON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:SHANISE
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:704-224-3260
Mailing Address - Street 1:339 ESTHER CIR
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-9026
Mailing Address - Country:US
Mailing Address - Phone:704-224-3260
Mailing Address - Fax:
Practice Address - Street 1:339 ESTHER CIR
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-9026
Practice Address - Country:US
Practice Address - Phone:704-224-3260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)