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General NPI Number Information
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NPI Number | 1932017712
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Entity Type | Organization
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Legal Business Name | THE BLACK MALES INSTITUTE OR THE BLACK MALES THERAPY CLINIC
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Dates
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Enumeration Date | 08/31/2026
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Last Update Date | 08/31/2026
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Provider Practice Location Address
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Address Line | 1923 J N PEASE PL STE 104
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City | CHARLOTTE
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State | NC
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Zip | 28262-4534
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Country | US
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Telephone | 980-247-0693
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Fax |
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Provider Business Mailing Address
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Address Line | 7717 BRIDLE CT
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City | CHARLOTTE
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State | NC
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Zip | 28216-8730
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Country | US
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Telephone | 980-247-0693
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Fax | 980-500-0447
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Authorized Official
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Title or Position | PRINCIPLE OWNER/THERAPIST
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Name | MR. SEAN WASHINGTON
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Credential | MA, LCMHC
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Telephone | 980-247-0693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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