MEDICARE: AREAONIA BLALOCK LCMHC-A, LCAS-A

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-31116	NC
2	101YM0800X	Mental Health Counselor	A22806	NC

General Provider Information

NPI Number	:	1972446532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AREAONIA BLALOCK LCMHC-A, LCAS-A

Provider Business Mailing Address
First Line	:	1067 BRENTWAY AVE STE 124
Second Line	:
City	:	WILLIAMSTON
State	:	NC
Zip	:	27892-7592
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 MCCARTHY BLVD STE B
Second Line	:
City	:	NEW BERN
State	:	NC
Zip	:	28562-2033
Country	:	US
Telephone Number	:	919-588-3697
Fax Number	:

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

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/19/2026

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