Provider Demographics
NPI:1346700416
Name:SOMERVILLE, BLAIR ASHLEY (LCMHC)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:ASHLEY
Last Name:SOMERVILLE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7406 CHAPEL HILL RD STE J
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-5039
Mailing Address - Country:US
Mailing Address - Phone:864-699-0602
Mailing Address - Fax:919-573-0438
Practice Address - Street 1:18 W COLONY PL STE 120
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5597
Practice Address - Country:US
Practice Address - Phone:919-666-7009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14601101YP2500X
NC14601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional