Provider Demographics
NPI:1396880399
Name:BLEVINS, PRISCILLA YVONNE (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:YVONNE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:MSW LCSW
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 15409
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-5409
Mailing Address - Country:US
Mailing Address - Phone:252-638-0123
Mailing Address - Fax:252-638-1996
Practice Address - Street 1:1315 S GLENBURNIE RD
Practice Address - Street 2:SUITE C-13
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2613
Practice Address - Country:US
Practice Address - Phone:252-638-0123
Practice Address - Fax:252-638-1996
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0033551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002855Medicaid
NC137F8OtherBLUE CROSS BLUE SHIELD
NC6002855Medicaid
NC2878241Medicare PIN