Fontasia Monique Wade-Blivens

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P012334 Issued in NC

Practice address

820 Grimes Blvd
Lexington, NC 27292-7640

Phone

(336) 224-6071

NPI assigned

Jul 31, 2018

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

Medicare enrollment (NPD)

Enrolled

State licenses

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 and National Provider Directory roles.

• Pediatric and Family Behavioral Health Acquisition Group PLLC

  • Psychiatry Physician
  • Charlotte, NC
  • NPI 1770056038
  Medicare reassignment NPD

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532995200000",
    "number": "1568940773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 PEE DEE AVE STE 101",
            "city": "ALBEMARLE",
            "state": "NC",
            "postal_code": "280014945",
            "telephone_number": "704-986-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 GRIMES BLVD",
            "city": "LEXINGTON",
            "state": "NC",
            "postal_code": "272927640",
            "telephone_number": "336-224-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE-BLIVENS",
        "first_name": "FONTASIA",
        "middle_name": "MONIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-31",
        "last_updated": "2018-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P012334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Lee Vanderburg, FNP-C
• Leslie Denise Varner, RN
• Izzah Vasim, M.D
• Brooke Nicole Vinson, MD
• Nicolas Vu, OD
• David H Wagner, MD
• Wake Forest Baptist Health
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences
• Wake Forest University Health Sciences

• Clinical Social Worker in Lexington, NC
• Providers in Lexington, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.