Provider Demographics
NPI:1679777494
Name:BLUE, NEIL (LPC)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:BLUE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4276 LEGEND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-1965
Mailing Address - Country:US
Mailing Address - Phone:910-867-0035
Mailing Address - Fax:
Practice Address - Street 1:4276 LEGEND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-1965
Practice Address - Country:US
Practice Address - Phone:910-867-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103649Medicaid