Provider Demographics
NPI:1891045753
Name:BLUE, CIJI LATRICE (LCSWA)
Entity Type:Individual
Prefix:
First Name:CIJI
Middle Name:LATRICE
Last Name:BLUE
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26269
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5021
Mailing Address - Country:US
Mailing Address - Phone:919-760-3026
Mailing Address - Fax:
Practice Address - Street 1:6319 RAEFORD RD APT 71
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2838
Practice Address - Country:US
Practice Address - Phone:919-760-3026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0090621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical