KIMBERLY ANNE BLACKMON LPC, NCC, LCAS, CCS
NPI 1083747224
Counselor - Addiction (Substance Use Disorder) in Charlotte, NC

Q: What is the provider's specialty?

The provider's specialty is Counselor with taxonomy code 101YA0400X and a focus in Addiction (Substance Use Disorder).

Active since March 14, 2007

429 BILLINGSLEY RD, MECKLENBURG COUNTY AMH SASC, CHARLOTTE, NC 28211(704) 336-5651(704) 336-5105 Get Directions Write a Review

NPPES record last updated: October 22, 2014. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Kimberly Anne Blackmon Lpc, Ncc, Lcas, Ccs NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KIMBERLY ANNE BLACKMON LPC, NCC, LCAS, CCS (NPI 1083747224) is an individual addiction (substance use disorder) provider in Charlotte, North Carolina, licensed in North Carolina (398) and active in the NPI registry since March 2007.

NPPES Registry Identity

NPI1083747224

Entity TypeIndividualFemale

Primary Taxonomy101YA0400X

Provider Legal NameKIMBERLY ANNE BLACKMONCredential: LPC, NCC, LCAS, CCS

Location Address429 BILLINGSLEY RD, MECKLENBURG COUNTY AMH SASCCharlotte, NC 28211-1007

Mailing Address12631 Bullock Greenway BlvdCharlotte, NC 28277-8177 · (980) 245-8433

Phone(704) 336-5651

Fax(704) 336-5105

Sole ProprietorYes

Enumeration DateMarch 14, 2007

Last NPPES UpdateOctober 22, 2014

✔ NPI 1083747224 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers

Taxonomy Code101YA0400X

License✔ Licensed in NC · 398

Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License 3706S (NC)

429 BILLINGSLEY RD, Charlotte, NC 28211

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Other Names 1

Former Name (1)Kimberly Anne Phillips Lpcs, Lcas, Ccs, Ncc

Other Identifiers 1

Medicaid6102838NC

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. TONY RAY BEATTY LCAS, CCS

Counselor (Addiction (Substance Use Disorder))