MEDICARE: CORINNE BLACKMON MA, LCMHC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	068.0137122TELE	VT
2	101YM0800X	Mental Health Counselor	18358	NC
3	101YM0800X	Mental Health Counselor	11893	SC

General Provider Information

NPI Number	:	1396440624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE BLACKMON MA, LCMHC, LPC

Provider Business Mailing Address
First Line	:	3210 N PLEASANTBURG DR # 1096
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29609-2925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 N PLEASANTBURG DR # 1096
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29609-2925
Country	:	US
Telephone Number	:	904-440-0295
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/30/2026

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