Provider Demographics
NPI:1356005706
Name:BLUE ROSE COUNSELING, PLLC
Entity Type:Organization
Organization Name:BLUE ROSE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LOVELADY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS, CSI
Authorized Official - Phone:919-612-1213
Mailing Address - Street 1:3710 SHANNON RD UNIT 52054
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27717-0750
Mailing Address - Country:US
Mailing Address - Phone:919-612-1213
Mailing Address - Fax:919-287-2245
Practice Address - Street 1:1415 W NC HIGHWAY 54 STE 111
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-5597
Practice Address - Country:US
Practice Address - Phone:919-612-1213
Practice Address - Fax:919-287-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083080592OtherNPPES