Provider Demographics
NPI:1396440624
Name:BLACKMON, CORINNE (MA, LCMHCA, LPCA)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:MA, LCMHCA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22-C NEW LEICESTER HWY
Mailing Address - Street 2:PMB #103
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 MARKET POINT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6587
Practice Address - Country:US
Practice Address - Phone:904-440-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18358101YM0800X
SC8349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health