Provider Demographics
NPI:1336411297
Name:BLACKMON, TOMEKIA SHERIE (LCSWA)
Entity type:Individual
Prefix:
First Name:TOMEKIA
Middle Name:SHERIE
Last Name:BLACKMON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PATRICK DR.
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-9515
Mailing Address - Country:US
Mailing Address - Phone:252-327-2365
Mailing Address - Fax:252-756-5246
Practice Address - Street 1:1108 A KINGOLD BLVD
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-9515
Practice Address - Country:US
Practice Address - Phone:252-747-5705
Practice Address - Fax:252-747-5635
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1961101YA0400X
NC1041C0700X
SC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)