Provider Demographics
NPI:1417511510
Name:BLUE LOTUS COUNSELING , LLC
Entity Type:Organization
Organization Name:BLUE LOTUS COUNSELING , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMESA
Authorized Official - Middle Name:DASHANT
Authorized Official - Last Name:MOTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-960-5429
Mailing Address - Street 1:PO BOX 4965
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-6965
Mailing Address - Country:US
Mailing Address - Phone:803-960-5429
Mailing Address - Fax:877-752-1347
Practice Address - Street 1:223 E MAIN ST STE 401
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4571
Practice Address - Country:US
Practice Address - Phone:803-960-5429
Practice Address - Fax:877-752-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC1594Medicaid