Provider Demographics
NPI:1518369727
Name:PRATT, NIADRA BLOUNT (MS, LCAS, CCS, LPCA)
Entity Type:Individual
Prefix:
First Name:NIADRA
Middle Name:BLOUNT
Last Name:PRATT
Suffix:
Gender:F
Credentials:MS, LCAS, CCS, LPCA
Other - Prefix:
Other - First Name:NIADRA
Other - Middle Name:CHANTE
Other - Last Name:BLOUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCASA
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:CHOCOWINITY
Mailing Address - State:NC
Mailing Address - Zip Code:27817-0644
Mailing Address - Country:US
Mailing Address - Phone:252-256-7219
Mailing Address - Fax:252-364-3414
Practice Address - Street 1:51 NC HWY 33 WEST
Practice Address - Street 2:
Practice Address - City:CHOCOWINITY
Practice Address - State:NC
Practice Address - Zip Code:27817
Practice Address - Country:US
Practice Address - Phone:252-256-7219
Practice Address - Fax:252-364-3414
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15315101YM0800X
NCLCASA20451101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health