Blue Heron Wellness LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10640 Issued in SC

Legal business name

BLUE HERON WELLNESS LLC

Practice address

719 S Lake Dr
Lexington, SC 29072-3432

Phone

(803) 609-7792

Fax

(803) 816-9058

NPI assigned

May 17, 2018

Organization subpart

No

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

Authorized official

Name

Renea Christine Mable, LISW-CPNPI 1629568472

Title

Owner

Phone

(803) 429-9065

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Renea Christine Mable, LISW-CP

  • Clinical Social Worker
  • Lexington, SC
  • NPI 1629568472
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626739200000",
    "number": "1679063424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 FIREBRIDGE DR",
            "city": "CHAPIN",
            "state": "SC",
            "postal_code": "290367639",
            "telephone_number": "803-429-9065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 S LAKE DR",
            "city": "LEXINGTON",
            "state": "SC",
            "postal_code": "290723432",
            "telephone_number": "803-609-7792",
            "fax_number": "803-816-9058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE HERON WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-17",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A",
        "authorized_official_last_name": "MABLE",
        "authorized_official_first_name": "RENEA",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-429-9065",
        "authorized_official_credential": "LISW-CP"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "SC",
            "license": "10640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Lewis Bloodworth III, APRN
• Bloom Pediatric Therapy, LLC
• Bloom Therapy and Wellness, LLC
• Ashley May Bloomberg
• Francis Blubaugh
• Karen Small Boatwright
• Gordon H Bobbett II, MD
• Megan S Boltin, M.D.
• Michael Patrick Boltin
• Hannah Bolton

• Clinical Social Worker in Lexington, SC
• Providers in Lexington, SC by specialty
• Clinical Social Worker in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.