Healthcare Provider Details

I. General information

NPI: 1932017712
Provider Name (Legal Business Name): THE BLACK MALES INSTITUTE OR THE BLACK MALES THERAPY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 J N PEASE PL STE 104
CHARLOTTE NC
28262-4534
US

IV. Provider business mailing address

7717 BRIDLE CT
CHARLOTTE NC
28216-8730
US

V. Phone/Fax

Practice location:
  • Phone: 980-247-0693
  • Fax:
Mailing address:
  • Phone: 980-247-0693
  • Fax: 980-500-0447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN WASHINGTON
Title or Position: PRINCIPLE OWNER/THERAPIST
Credential: MA, LCMHC
Phone: 980-247-0693