Active NPI
Traci Chevonn Blue, LPC
- Mental Health Counselor
- Raleigh, NC
National Provider Identifier
1174678155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 4643
- Practice address
- 317 W Morgan St
Apt 410
Raleigh, NC 27601-1472 - Phone
- (919) 835-0809
- NPI assigned
- Jan 23, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 4643 | NC | Primary |
Addresses
Primary practice location
317 W Morgan St
Apt 410
Raleigh, NC 27601-1472
Mailing address
317 W Morgan St
Apt 410
Raleigh, NC 27601-1472
Phone (919) 835-0809
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4643 | NC | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228867200000",
"number": "1174678155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "317 W MORGAN ST",
"address_2": "APT 410",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276011472",
"telephone_number": "919-835-0809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 W MORGAN ST",
"address_2": "APT 410",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276011472",
"telephone_number": "919-835-0809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLUE",
"first_name": "TRACI",
"middle_name": "CHEVONN",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-23",
"last_updated": "2008-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "4643",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.