Provider Demographics
NPI:1457163651
Name:BLUNT, FAREIZA (LCSWA)
Entity type:Individual
Prefix:MRS
First Name:FAREIZA
Middle Name:
Last Name:BLUNT
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 1:110 AUBURN BAY DR
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27863-4404
Mailing Address - Country:US
Mailing Address - Phone:818-967-9645
Mailing Address - Fax:
Practice Address - Street 1:110 AUBURN BAY DR
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:NC
Practice Address - Zip Code:27863-4404
Practice Address - Country:US
Practice Address - Phone:818-967-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0194991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty