Provider Demographics
NPI:1982220323
Name:BLUE, LAUREN (LCMHC, LCAS, CCTP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BLUE
Suffix:
Gender:F
Credentials:LCMHC, LCAS, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LAKE CLAIR PL APT E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2517
Mailing Address - Country:US
Mailing Address - Phone:757-642-8981
Mailing Address - Fax:
Practice Address - Street 1:110 LAKE CLAIR PL APT E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2517
Practice Address - Country:US
Practice Address - Phone:757-642-8981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26431101YA0400X
NCA15757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)