Provider Demographics
NPI:1578701389
Name:BLUE, FELIPE KHRISTOPHER (LCAS-P)
Entity Type:Individual
Prefix:MR
First Name:FELIPE
Middle Name:KHRISTOPHER
Last Name:BLUE
Suffix:
Gender:M
Credentials:LCAS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 MORREENE RD
Mailing Address - Street 2:APARTMENT 15L
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4524
Mailing Address - Country:US
Mailing Address - Phone:843-628-6384
Mailing Address - Fax:
Practice Address - Street 1:355 S MADISON BLVD
Practice Address - Street 2:SUITE C1
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-5485
Practice Address - Country:US
Practice Address - Phone:336-599-8366
Practice Address - Fax:336-322-6168
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)