Provider Demographics
NPI:1083153563
Name:BLUE, TYEEKIA (MSW, LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:TYEEKIA
Middle Name:
Last Name:BLUE
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 MAIN ST
Mailing Address - Street 2:STE 213
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7448
Mailing Address - Country:US
Mailing Address - Phone:864-906-0818
Mailing Address - Fax:980-206-0709
Practice Address - Street 1:4350 MAIN ST
Practice Address - Street 2:STE 213
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7448
Practice Address - Country:US
Practice Address - Phone:980-236-1704
Practice Address - Fax:980-206-0709
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC012307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health