Tyeekia Blue, MSW, LCSWA

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C012307 Issued in NC

Practice address

4350 Main St
Ste 213
Harrisburg, NC 28075-7448

Phone

(980) 236-1704

Fax

(980) 206-0709

NPI assigned

Feb 17, 2017

Last updated

Jan 31, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Essential Wellness Counseling PLLC

  • Mental Health Counselor
  • Harrisburg, NC
  • NPI 1740805019
  Medicare reassignment NPD Authorized official
• Iqlabtests LLC

  • Clinical Medical Laboratory
  • Concord, NC
  • NPI 1649938895
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643587200000",
    "number": "1083153563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 MAIN ST",
            "address_2": "STE 213",
            "city": "HARRISBURG",
            "state": "NC",
            "postal_code": "280757448",
            "telephone_number": "864-906-0818",
            "fax_number": "980-206-0709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 MAIN ST",
            "address_2": "STE 213",
            "city": "HARRISBURG",
            "state": "NC",
            "postal_code": "280757448",
            "telephone_number": "980-236-1704",
            "fax_number": "980-206-0709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUE",
        "first_name": "TYEEKIA",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSWA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-17",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "C012307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benchmark Physical Therapy of NC, LLC
• Colleen Rochelle Black, MD
• Tanika Blackmon, LPN
• Esther Lavenia Blanks-Sheard, MD
• Blue Rabbit Logistics & Solutions LLC
• Crystal Michelle Boggs, FNP
• Jennifer Bourbonnais, MED, RD, LDN
• Julia Kihm Bregenzer, MD
• Stephanie Nichol Briscoe, MA LCMHCS NCC CTMH
• Fredericka Brooks, FNP

• Mental Health Counselor in Harrisburg, NC
• Providers in Harrisburg, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.