Provider Demographics
NPI:1225387376
Name:BLACKMAN, MICHELE CHRISTINE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:CHRISTINE
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N LAFAYETTE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3978
Mailing Address - Country:US
Mailing Address - Phone:704-284-0554
Mailing Address - Fax:
Practice Address - Street 1:809 N LAFAYETTE ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3978
Practice Address - Country:US
Practice Address - Phone:704-284-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist